new hampshire aemt pharmacology new hampshire division of fire standards & training and...
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New Hampshire AEMT
Pharmacology
New HampshireNew Hampshire
Division of Fire Standards & Training andDivision of Fire Standards & Training andEmergency Medical ServicesEmergency Medical Services
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Special Thank you!
Jeanne Erickson, NREMT-I Christopher Rousseau, NREMT-I
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AEMT Medications
Activated Charcoal Epinephrine – cardiac Epinephrine –
anaphylaxis Dextrose Atropine Narcan Ipratropium Albuterol Aspirin Nitroglycerin
Glucagon Oral Glucose Nitrous Oxide Oxygen
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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
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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.
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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.
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Objectives
Review of the following medical emergencies and the related NH Patient Care Protocols
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Drug
Chemical agents used in the diagnosis, treatment, or prevention of disease.
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Pharmacology
The study of drugs and their interactions with the body.
Drugs are NOT magical. They cannot alter the body
systems qualitatively, only quantitatively
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Names
Chemical 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
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As an example: Epinephrine
Chemical Name: 4-(1-hydroxy-2-methylamino-ethyl)benzene-1,2-
diol
Generic name: epinephrine
Official name: epinephrine
Brand name: Adrenalin, EpiPen®
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Source
Plants Purple foxglove = digitalis Deadly nightshade Atrope belladonna plant = Atropine
Animal Insulin (bovine & porcine)
Mineral Calcium Chloride, magnesium sulfate
Laboratory (synthetic) Fentanyl
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Reference Materials
USP (United States Pharmacopoeia)
PDR (Physician’s Desk Reference) Drug Information
Monthly Prescribing Reference
AMA (American Medical Association) Drug Evaluation
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Drug Profile
Names Classifications Mechanism of action Indications Pharmacokinetics Side effects/adverse reactions Contraindications Dosages How supplied Special considerations
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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
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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
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Special considerations in drug therapy Pregnant patientsPregnant 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
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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
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Scope of Management
AEMT’s are held responsible for safe and therapeutically effective drug administration
AEMT’s are personally responsiblepersonally responsible - legally, morally, and ethically - for each drug they administer
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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
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Review of the Nervous System
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Patient’s Rights
Right medication Right dose Right time Right route Right patient Right documentation
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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
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Pharmacokinetics
Absorption
Distribution
Biotransformation
Elimination
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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
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Absorption
Speed of absorption (in order)
Intravenous / Intraosseous
Transtracheal (ETT)
Sublingual
Rectal
Intramuscular
Subcutaneous
Oral
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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
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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
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EliminationElimination – 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
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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
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Pharmacodynamics
Drug Receptor Interactions Agonist Antagonist Affinity Efficacy
Types of receptors Beta Alpha
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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
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Receptor Sites
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Factors altering drug responses
Age Body mass Sex Environmental milieu Time of administration Pathologic state Genetic factors Psychological factors
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Drug Routes
Enteral PO Orogastric/naogastric SL Buccal Rectal
Parenteral IV ET IO Umbilical IM SQ Inhalation/nebulized Topical Transdermal Nasal Instillation Intradermal
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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:
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Action of Drugs
Bind to a receptor site
Change the physical properties of cells
Chemically combine with other chemical
Alter the normal metabolic pathway
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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
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Unpredictable adverse responses
Anaphylaxis
Delayed reaction
Tolerance
Drug dependence
Summation (addition or additive effect)
Potentiation
Interference
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Predictable Responses
Desired action Side effects
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Body Substance Isolation Equipment
Always take appropriate body substance isolation measures to reduce your risk of
exposure during medication administration
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Drug Storage
Storage considerations Temperature Light Moisture Shelf Life
Security Accountability
Logs
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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
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DefinitionsMetric 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
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Weights & MeasuresMetric 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
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Conversion between Prefixes
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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 0.001 gm
Microgram (mcg or μg)= 1/1,000,000 or 0.000001
1 Liter (l)= 1,000 milliliters (ml)
ml = cc
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Weights & Measures –
Apothecary 1 grain = 60 milligrams ¼ grain = 15 milligrams
Household 1 teaspoon = 5 ml 1 tablespoon = 15 ml 1 ounce = 30 ml 8 ounces = 240 ml 1 quart = 946 ml
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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
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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 uniti.e. 10 mg / 2 ml
Volume of Drug on Hand – the amount of fluid within the vial or ampoule Expressed in ml or cc
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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 100x = 75 100x = 75 1 ml x ml 100 100
x = 75 x = 0.75 ml 100
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Drug Calculations
Converting Pounds to Kilograms: 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
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Medications via Inhalation Route
Broncholdiator (beta angonist)
Equipment oxygen nebulizer adapters
Administering Indications Techniques Precautions General principals
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Parenteral Administration
Subcutaneous
Intramuscular
Intravenous bolus
Intraosseous
Sublingual
Equipment: syringes, needles, ampules, vials, prefilled syringes, others
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Subcutaneous Injection
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Intramuscular Injection
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Sublingual Route
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Intravenous Bolus
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Prefilled / Preloaded Syringes
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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
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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
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Intravenous Med Administration
Select administration port Port closest to the
patient Cleanse
Pinch the tubing upstream from the port
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Intravenous Med Administration Administer the medication Flush the line Re-assess the patient Re-adjust the rate
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QUESTIONS