1. NM Pharmacology for First Responders

2. Lesson Goal Introduce drug names, forms, and indications for use, as well as how to assist patients with taking their prescribed medications

3. Drug Names Generic (scientific/chemical name) –Listed in U.S. Pharmacopeia –Example Aspirin Trade (brand) –Example Bayer, Anacin

4. Forms of Medication Oral –Per os (PO) –Patient must be awake Patient must be able to follow commands Must be swallowed –Enters bloodstream through digestive system Takes effect in 30-60 min

5. Forms of Medication Inhaled –Medication is inhaled into the lungs Rapidly absorbed Easy to administer –Inhaler or nebulizer

6. Forms of Medication Buccal –Between cheek and gums –Oral glucose

7. Vital Drug Information 6 pieces of information for every medication –Indications –Dosage –Administration –Actions –Side effects –Contraindications

8. Vital Drug Information Indications –Reason for administering medication –Nitroglycerin Indicated for angina Dosage –How much

9. Vital Drug Information Administration –Route Actions –Desired effects Nitroglycerin dilates coronary arteries to relieve chest pain

10. Vital Drug Information Side effects –Undesirable effects Contraindications –Conditions in which medication must not be given Nitroglycerin contraindicated for patients who have recently taken drug for erectile dysfunction

11. Medication Examination Correct medication –Seal intact –Color –No precipitate (floaters) Correct concentration Check expiration date

12. Allowable Drugs Administer the following drugs with Service Medical Director Approval –Oral glucose preparations –Aspirin PO for adults with suspected cardiac chest pain –IM auto-injector of atropine and or pralidoxime for treatment of chemical and/or nerve agent exposure –Albuterol via inhaled administration –Ipratopiem via inhaled administration, in combination with albuterol –Epinephrine via auto-injector device –Patient’s own bronchodilator using pre-measured or MDI device

13. Metered Dose Inhaler (MDI) You may assisted with a patient’s own bronchodilator using pre- measured or MDI device –Need on-line medical control drug Absorbed from alveoli into the pulmonary capillaries –Onset of action 1 - 3 minutes Patient must be awake

14. IM Auto-injection Epinephrine Nerve agent exposure –Atropine –Pralidoxime

15. Acetylsalicylic Acid (ASA) CLASS OF DRUG –Anti-inflammatory, analgesic, antipyretic, anticoagulant INDICATIONS –Myocardial infarction patients, including suspected AMI patients. CONTRAINDICATIONS –Hypersensitivity –Bleeding disorders –Asthma (Relative) ADMINISTRATION –Adult: [160-325 mg] orally for AMI (prefer chewable) SPECIAL NOTES –All patients with suspected AMI and without contraindications receive aspirin

16. Albuterol CLASS OF DRUG –Sympathomimetic, Beta 2 selective adrenergic bronchodilator INDICATIONS –Albuterol is used to treat reversible airway obstruction caused by: Wheezing associated with asthma, COPD (emphysema), chronic bronchitis CONTRAINDICATIONS –Hypersensitivity DRUG INTERACTION –Beta adrenergic agents - potentiates the effects –MAO inhibitors - may lead to hypertensive crisis –Beta adrenergic blockers - decreases the effectiveness ADMINISTRATION –Nebulizer –Adult: [2.5-5.0 mg] (up to 10 mg) given over 5-15 minutes, may be repeated as necessary. –Pediatric: [1.25-2.5 mg] (up to 5 mg) given over 5-15 minutes, may be repeated as necessary. SPECIAL NOTES –Most side effects are dosage related

17. Ipratropium (Atrovent) CLASS OF DRUG –Anticholinergic INDICATIONS –Bronchial asthma –Reversible bronchospasm associated with chronic bronchitis and emphysema CONTRAINDICATIONS –Hypersensitivity to the drug –Acute treatment of bronchospasm where rapid response is required. DRUG INTERACTION –Few in the pre-hospital setting ADMINISTRATION –Should be administered in conjunction with beta agonist therapy. –Adult: 250 – 500mcg (.25 -.5 mg) via nebulization SPECIAL NOTES –The vital signs must be monitored during therapy. –Caution should be used when administering it to elderly patients and those with cardiovascular disease or hypertension.

18. Epinephrine (1:1,000) CLASS OF DRUG –Sympathomimetic INDICATIONS –Severe Bronchospasm –Anaphylaxis CONTRAINDICATIONS –None when indicated DRUG INTERACTION –Reduced effects with Beta-adrenergic blocker ADMINISTRATION –Auto-injector SPECIAL NOTES –Increased cardiac workload can precipitate angina and/or AMI –Use with caution on patients with peripheral vascular insufficiency –Wheezing in the elderly is pulmonary edema or pulmonary embolus until proven otherwise

19. Glucose (Dextose) CLASS OF DRUG –Carbohydrate, nutrient, short acting osmotic diuretic INDICATIONS –Symptomatic hypoglycemia Known diabetic actively seizing CONTRAINDICATIONS –Intra-cranial bleeds or suspected CVA (relative) –Unconscious (for oral glucose) DRUG INTERACTION –None ADMINISTRATION –Oral: [12-25 gm] of paste, may be spread with a tongue depressor. SPECIAL NOTES –Attempts at documenting hypoglycemia via automatic glucometry should be made before administration.

20. Oxygen CLASS OF DRUG –Gas INDICATIONS –Suspected hypoxia or respiratory distress from any cause CONTRAINDICATIONS –None DRUG INTERACTION –None ADMINISTRATION –Adult & Pediatric Dosage Low flow (NC 1 - 2 L/Min) Moderate flow (NC 4 - 6 L/Min) High flow (NRB 10 - 15 L/Min) SPECIAL NOTES –BE PREPARED TO ASSIST VENTILATION, IF NEEDED. –Nasal prongs work equally well on nose and mouth breathers. –Giving 100 % oxygen to all patients is unnecessary. If the patient has 96% O2 saturation and is in no acute distress, a NRB is not necessary.

21. The Six Rights Right D rug Right R oute Right P atient Right A mount Right T ime Right S cribe Helps prevent medication errors!

22. Allergies Always ask about medication allergies before administering a medication!

23. Sharps Control Place syringe with needle immediately into sharps container Do NOT recap the needle

24. Assessment of Effectiveness After medication administration: –Reassess early & often V/S Patient assessment –Document findings/changes

25. Summary Many patients carry medications for chronic medical conditions Know how to obtain drug information On-line medical direction sometimes required Patients must be re-evaluated

26. Questions?