Post on 21-Jun-2015
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EMT Pharmacology ReviewAlan Batt
Clinical Educator, CCP
Pharmacology
• At the completion of this module, the student will be able to safely administer the appropriate medication and also correctly monitor medicated patients in accordance with the appropriate CPG(s) and scope of practice for an EMT.
Pharmacology
• Is the study of how medications interact with living organisms to produce a change in function.
Pharmacological Definitions• Definitions• Pharmacodynamics
• The study of how a medication acts on a living organism• The way in which a medication produces the intended
response• Also known as the mechanism of action
Theories of Drug Action
• Four mechanisms• Bind to a receptor site• Change the physical properties of cells• Chemically combine with other chemicals• Alter a normal metabolic pathway
• Medication molecules will have 1 of 2 effects when it attaches to a receptor site.
• Agonist• it will stimulate the receptor site to cause the response
• Antagonist• it may block the receptor site from being stimulated by
other chemical mediators & inhibits the normal response.
Factors affecting drug response• Age • Weight • Gender • Environment • Route of administration • Condition of the patient • Genetic factors • Psychological factors
Medications which the EMT may administer • Aspirin• Oxygen• Glucose Gel• GTN• Salbutamol • Epinephrine (1:1,000) (auto injector)• Glucagon• Nitrous oxide & Oxygen (Entonox)• Paracetamol
Presentations
Medication
• Route• Oral (PO)• Rectal (PR)• Subcutaneous (SQ)• Sublingual (SL)• Intramuscular (IM)• Inhalation (IN)• Intravenous (IV)• Intraosseous (IO)
• Time for Effect• 30 – 90 mins• 05 – 30 mins• 15 – 30 mins• 03 – 05 mins• 10 – 20 mins• 03 – 05 mins• 30 – 60 seconds• 30 – 60 seconds
Pharmacology of EMT Medications• Aspirin (ASA)• Antithrombotic.• Inhibits the formation of thromboxane A2, which
stimulates platelet aggregation and artery constriction. • This reduces clot / thrombus formation in an MI.
Pharmacology of EMT Medications (Cont.)
• Epinephrine (1:1 000)• Alpha and beta adrenergic stimulant.• Reversal of laryngeal oedema & bronchospasm in
anaphylaxis.• Antagonises the effects of histamine.
Pharmacology of EMT Medications (Cont.)
• Glucagon• Glycogenolysis.
• the conversion of glycogen polymers to glucose monomers in the liver
• Increases plasma glucose by mobilising glycogen stored in the liver.
Pharmacology of EMT Medications (Cont.)
• Glucose Gel• Increases blood glucose levels
Pharmacology of EMT Medications (Cont.)
• Glycerol Trinitrate (GTN)• Vasodilator.• Dilates systemic veins reducing venous return to the
heart (pre-load) and thus reduces the heart workload.• Reduces BP.• Releases nitric oxide which acts as a vasodilator. Dilates
coronary arteries particularly if in spasm increasing blood flow to myocardium.
Pharmacology of EMT Medications (Cont.)
• Morphine• Opiate Analgesic.• Acts on Central Nervous System to reduce pain &
anxiety.• Vasodilatation resulting in reduced pre-load to
myocardium.
Pharmacology of EMT Medications (Cont.)
• Nitrous Oxide 50% and Oxygen 50% (ENTONOX®)• Analgesic agent gas:
• CNS depressant.• Pain relief.
Pharmacology of EMT Medications (Cont.)
• Oxygen• Oxygenation of tissue/organs.
• Paracetamol• Analgesic – central prostaglandin inhibitor.• Antipyretic – prevents the hypothalamus from
synthesising prostaglandin E, inhibiting the temperature from rising further.
Pharmacology of EMT Medications (Cont.)
• Salbutamol• Beta 2 agonist.
• Causing smooth muscle relaxation• Bronchodilation.• Relaxation of smooth muscle.
Define the terms:
• Side Effects• is an effect, whether therapeutic or adverse, that is
secondary to the one intended
• Indications• is a valid reason to use a certain medication
• Contraindications• is a reason to withhold a certain medication
• Adverse Reactions• is an expression that describes harm associated with the
use of given medications at a normal dosage
Differentiate between:• Trade Name• A name used to identify a commercial product or
service, which may or may not be registered as a trademark. Also called brand name.
• Generic Name• The term "generic" has several meanings as regards
medications:• The chemical name of a drug.• A term referring to the chemical makeup of a drug rather than
to the advertised brand name under which the drug is sold.• A term referring to any drug marketed under its chemical name
without advertising.
Pre-administration Checks
• Full set of vitals• Check for allergies• Check for contraindications• Check if patient is taking complementary therapies• homeopathy
• Recheck indications• Recheck with your partner.
The '6 rights' of medication administration • Right patient• Right medication• Right dose• Right route• Right time• Right documentation (PCR)
• The 7th Right, is to ‘refuse’
A failure in any one of these “rights” is considered a
medication error
Dangers of inappropriate administration• Anaphylactic shock• Death• Breathing disorders• Gastric bleeding• Hypotension• Unconsciousness• Addiction
Aspirin
Epinephrine 1:1,000
Glucose Gel
Glucagon
GTN
Entonox
Ibuprofen
Naloxone
Oxygen
Paracetamol
Salbutamol
Formulae
(ml) administer toVol (ml)dilutent of Vol x(mg) have What you
(mg) want What you
• As per CPG• Child’s weight in kg = (Age x 3) + 7
• Calculating correct dose
Example - Paracetamol
• An EMT identifies a 3 year old requires paracetamol suspension PO• Paracetamol suspension
PO Dosage is?• 20mg/kg
• Standard Presentation• 120mg/5ml (other
250mg/5ml)
• Weight of Paediatric • (3x3)+7=16Kgs
Amount to Administer (mg)• 20mg x 16Kgs = 320mg
• Volume to administer:13.3ml 5mlx 120mg
320mg
Now you try!
4 year old child needs Paracetamol
What’s the child’s weight?(Age x 3) + 7 = ?
19kg
Dose of Paracetamol PO (suspension)is 20ml/kg
20 x 19 = ?
• 380mg is required dose
• Paracetamol comes in a 120mg in 5ml solution
• How much should we give?
15.8ml 5ml x120mg
380mg
Weight based v Age based
• Weight based • Ibuprofen• Midazolam• Naloxone• Paracetamol
• Age based• Epinephrine (1;1,000)• Glucagon • Glucose Gel• Salbutamol
A Question
• Your partner on a call draws up the medication for you to administer to a patient
• Who is legally responsible for it?
Units of Measurement
• 1 kilogram (kg) = 1000grams (g)• 1 gram (g) = 1000,000 (mcg)• 1 milligram (mg) = 1000micrograms (mcg)
• 1 litre (L) = 1000 (ml) millilitres
• You may find (cc) referred to, where 1ml equals 1cc