New Hampshire AEMT

Pharmacology

New HampshireNew Hampshire

Division of Fire Standards & Training andDivision of Fire Standards & Training andEmergency Medical ServicesEmergency Medical Services

Special Thank you!

Jeanne Erickson, NREMT-I Christopher Rousseau, NREMT-I

AEMT Medications

Activated Charcoal Epinephrine – cardiac Epinephrine –

anaphylaxis Dextrose Atropine Narcan Ipratropium Albuterol Aspirin Nitroglycerin

Glucagon Oral Glucose Nitrous Oxide Oxygen

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

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.

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.

Objectives

Review of the following medical emergencies and the related NH Patient Care Protocols

Drug

Chemical agents used in the diagnosis, treatment, or prevention of disease.

Pharmacology

The study of drugs and their interactions with the body.

Drugs are NOT magical. They cannot alter the body

systems qualitatively, only quantitatively

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

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®

Source

Plants Purple foxglove = digitalis Deadly nightshade Atrope belladonna plant = Atropine

Animal Insulin (bovine & porcine)

Mineral Calcium Chloride, magnesium sulfate

Laboratory (synthetic) Fentanyl

Reference Materials

USP (United States Pharmacopoeia)

PDR (Physician’s Desk Reference) Drug Information

Monthly Prescribing Reference

AMA (American Medical Association) Drug Evaluation

Drug Profile

Names Classifications Mechanism of action Indications Pharmacokinetics Side effects/adverse reactions Contraindications Dosages How supplied Special considerations

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

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

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

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

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

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

Review of the Nervous System

Patient’s Rights

Right medication Right dose Right time Right route Right patient Right documentation

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

Pharmacokinetics

Absorption

Distribution

Biotransformation

Elimination

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

Absorption

Speed of absorption (in order)

Intravenous / Intraosseous

Transtracheal (ETT)

Sublingual

Rectal

Intramuscular

Subcutaneous

Oral

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

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

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

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

Pharmacodynamics

Drug Receptor Interactions Agonist Antagonist Affinity Efficacy

Types of receptors Beta Alpha

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

Receptor Sites

Factors altering drug responses

Age Body mass Sex Environmental milieu Time of administration Pathologic state Genetic factors Psychological factors

Drug Routes

Enteral PO Orogastric/naogastric SL Buccal Rectal

Parenteral IV ET IO Umbilical IM SQ Inhalation/nebulized Topical Transdermal Nasal Instillation Intradermal

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:

Action of Drugs

Bind to a receptor site

Change the physical properties of cells

Chemically combine with other chemical

Alter the normal metabolic pathway

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

Unpredictable adverse responses

Anaphylaxis

Delayed reaction

Tolerance

Drug dependence

Summation (addition or additive effect)

Potentiation

Interference

Predictable Responses

Desired action Side effects

Body Substance Isolation Equipment

Always take appropriate body substance isolation measures to reduce your risk of

exposure during medication administration

Drug Storage

Storage considerations Temperature Light Moisture Shelf Life

Security Accountability

Logs

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

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

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

Conversion between Prefixes

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

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

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

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

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

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

Medications via Inhalation Route

Broncholdiator (beta angonist)

Equipment oxygen nebulizer adapters

Administering Indications Techniques Precautions General principals

Parenteral Administration

Subcutaneous

Intramuscular

Intravenous bolus

Intraosseous

Sublingual

Equipment: syringes, needles, ampules, vials, prefilled syringes, others

Subcutaneous Injection

Intramuscular Injection

Sublingual Route

Intravenous Bolus

Prefilled / Preloaded Syringes

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

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

Intravenous Med Administration

Select administration port Port closest to the

patient Cleanse

Pinch the tubing upstream from the port

Intravenous Med Administration Administer the medication Flush the line Re-assess the patient Re-adjust the rate

QUESTIONS