hello and welcome to chapter 12 principles of pharmacology emergency care and transportation of the sick and injured 12th edition repeat this chapter and the related coursework you will understand the significance and characteristics of general pharmacology and will be able to identify describe and demonstrate the steps for assisting administering medications carried by an emt okay so as an introduction medications are an important intervention available to you as an emt and when used appropriately medications may alleviate pain and improve a patient's condition but failure to administer medication safely and competently can lead to serious consequences for a patient including death so let's talk about how medications work first we'll talk about medical definitions okay so pharmacology that's the signs of drugs including their ingredients preparation uses and actions on the body okay medication that's a substance used to treat or prevent disease or relieve pain pharmacodynamics is the process by which the medication works on the body and a medication can either produce an effect or block the receptors to prevent other chemicals or medications from binding an agonist is a medication that causes stimulation of receptors and an antagonist is a medication that binds to the receptor or blocks other medications or chemicals from attaching okay so dose that's the amount of medication that is given within it depends on the patient's weight age or desired action of the medication then you have action and the definition of action is the therapeutic effect that a medication is expected to have on the body so we talked about pharmacodynamics let's talk about pharmacokinetics and that's the actions of the body upon the medication so the onset of the action that's the time from the medication administration until clinical effects occur the duration that's the length of time that the clinical effects persist the elimination that's how medications and chemicals are removed from the body and then peak the point or period when the maximum clinical effect is achieved okay factors affecting how medication works depends on the route of the medication and shock states there are indications okay so indications are the reasons or conditions for which a particular medication is given then there's contra indications and those are situations in which a medication would either harm the patient or have no positive effect and so there's two different types of contraindications there's absolute contraindications and that's a situation in which the medication should never be given if um if there's a contra indication is present if this is okay and then there's a relative contraindication that's situations which the benefits of administering the drug may outweigh the risk okay so if somebody's completely allergic to medication it causes anaphylaxis well of course that's an absolute contraindication relative contraindication might be it causes nausea right okay so adverse effects and that's any action of the medication other than the desired ones you have a couple adverse effects so you have unintended effects and that's effects that are undesirable but pose little risk to the patient and then you have untowards effects and those are effects that can be harmful to the patient all right so we talked a little bit about different definitions now let's talk about names and the medication names so when we talk about names we talk about a generic name or trade name okay so the generic name is a simple clear non-proprietary name generic names are not capitalized and so you can see on the slide there's an example of ibuprofen ibuprofen is in lower case and then there's trade names and that is a brand name that the manufacturer gives the drugs okay so trade names begin with a capital letter and one drug may have more than one trade name okay so an example would be tylenol prescription drugs are distributed only by pharmacists and require a physician's order okay so but over-the-counter or otc drugs may be purchased directly without a prescription then there are other types of drugs and so um there are recreational drugs and those are drugs such as heroin or cocaine there are herbal remedies enhanced drugs vitamin supplements alternative medicines and any medicine that a patient takes can be pharmacologically active and can cause an effect so ask the patient about any and all medications or drugs they are taking all right so that we talked about drug names now let's talk about routes okay so routes of an administration okay so there are internal medications and then there are parallel internal medications okay so two different ways to think about it the internal medications are entered the bodies for the digestive system it's often a pillar liquid form such as a cough or a cold medicine okay and uh medications administered via this route tend to absorb slowly and are not commonly used in the emergency setting okay and then we have the para internal para internal medications and they enter the body by some other means often in liquid form administered through needles or syringes and absorbed more quickly and offer a offer a more predictable or measurable response then we have absorption and this is the process by which the medications travel through the body tissues into the bloodstream okay so here we have common routes of administration um you'll see pr and that is per rectum and that's basically means by rectum and it's easy to administer provides reliable absorption okay and then there's oral po and this is um by mouth and it takes as long as one hour for absorption to occur okay then you have intravenous and so that's into the vein iv and that's the fastest delivery but cannot be used for all medications okay and then you have io and that's into the bone and it reaches the bloodstream through the bone marrow it requires drilling a needle into the outer layer of the bone then you have sc which is subcutaneous injection and sub beneath and cutaneous skin okay so just what it sounds like it's an injection given into the fatty tissue between the skin and the muscle then you have intramuscular and just what it sounds like into the muscle that is usually absorbed quickly but not all medications can be administered by the im route okay you have inhalation that's breathed into the lungs it's absorbed into the bloodstream quickly it forms include aerosols or fine powders and sprays and then you have sublingual okay so a sub is under lingual tongue and it's just what it sounds like under the tongue it enters through the oral mucosa under the tongue and is absorbed into the bloodstream within minutes then you have transcutaneous trans is through and cutaneous we just talked about this skin so through the skin it'll also be called transdermal and these could be patch that you put on the skin it's a longer lasting effect than other routes okay and then you have intranasal that's i n and relatively new format for delivery of medication medication is pushed through a mucosal atomizer device so a mad device mucosal atomizer and it air slices a liquid for delivery into the nostril it's very quick absorption okay and on this table you could see the routes of administration and the routes of absorption rate okay so you have the internal and the para internal and um you could see that the internal is a very um by mouth is a slow route okay all right okay so medication forms in the form of the medication usually dictates the route of administration so the manufacturer chooses the form to ensure and the proper route of the administration timing of the medications release into the bloodstream and the effects of the target organs or body systems all right so let's talk about tablets and capsules most medications given by mouth are in tablet or capsule form capsules are gelatin shells filled with water or powder or liquid medication and tablets often contain other materials that are mixed with the medication and compressed then you have solutions and suspensions so a solution is a liquid mixture of one or more substances that cannot be separated simply solutions can be given by almost any route okay so when given by mouth solutions may be absorbed from the stomach fairly quickly because the medication is already dissolved so many solutions can be given by as an inim or sc subcutaneous injection okay a suspension is a mixture of fine grand particles that are distributed evenly throughout the liquid by shaking or stirring but do not absolve okay so suspensions separate if they are left alone and it's important to shake or swirl a suspension before it's administered all right then you have meter dose inhalers so liquids or solids that are broken into small enough droplets or particles can be inhaled and so a spray canister directs some substances through the nose and into the lungs it delivers the same amount of medication with each time and it's used and often used for respiratory illnesses such as asthma or emphysema then you have topical medications and these are lotions creams and ointments and they can be applied to the skin surface and affect only that area so some examples are hydrocortisone cream and neosporin ointments calamine lotion okay then you have trans cutaneous medications also referred to as transdermal so through the skin many transdermal medications have a systemic or a whole body effect so if you touch the medication with your skin you will absorb it just like the patient then you have gels so these are semi liquids and they are administered in capsules or through plastic tubes and there's a good example of gel that we use and that's that oral glucose for diabetic emergencies and then gas okay so one of the most commonly used gases is oxygen and usually delivered through a non-rebreather or nasal cannula general steps and administering medications medications should be administered only under the influen or the authorization of online or offline medical direction and you need to follow the rights and there's nine of them okay so follow the right patient you have to make sure that you have the right patient and you're going to ensure that the patient who needs the medication is the person who receives the medication and then the right medication and indication so verify the proper medication is and prescription right dose you're going to verify the form and dose of the medication the right route and you're going to verify the route of the medication the right time you need to check the expiration date and condition of the medicine right education you need to inform the patient of the medication you intend to administer including any likely adverse effects or unusual sensations he or she may experience the right to refuse so a patient with a decision making capacity can decline or refuse proposed interventions or medication and the right response and evaluation so monitor the patient's vital signs mental status signs of perfusion and respiratory effort after medication administration you need to assess for anticipated response and observe for any adverse medication effects okay and then number nine you need the right documentation you need to document your actions and the patient's response okay so medication administration so cross-check and procedures so using a verbal cross-check procedure that verifies you are giving the right drug and the right patient at the right dose has been found to reduce medication errors so this table in chapter 12 dash 3 that's the rights of medication that i just talked about and there's nine of them and just what i just mentioned so it's right patient right medication education right dose right route right time right education right to refuse right to response and evaluation and the right documentation so over the years emts have been allowed increasing responsibility to work with medications many departments have strict guidelines on when an emt is allowed to administer a medication okay so there's three different types of medication administration or or ways that you would be allowed to now there's the peer-assisted medication and that's when you administer medication to yourself or to your partner so for example if you're exposed to toxic agent you would do this okay then there's patient-assisted medication and this is when you assist the patient with administering his or her own medication so examples are an epi autoinjector or nitro or a metered dose inhaler then there is emt administration of medication okay so the emt directly administers the medication to the patient the patient may be severely confused or unable to understand the need for the medication so examples include oxygen oral glucose and aspirin medical control state guidelines and local protocols determine what an emt in your system may administer and you need to refer to your local standards to obtain a listing of how and when emts can administer medications okay so oral medications now we're going to talk about the steps okay so follow the following steps to perform oral medications we want to take standard precautions okay then we're going to confirm the medication has not expired we need to obtain medical direction per our local protocol so we need to confirm that the patient has a patent airway and is able to swallow or chew this medication okay we need to monitor the patient's condition and then document so oral glucose oral glucose is a sugar that cells use for energy it is necessary for brain cells to survive and hypoglycemia that is extremely low glucose so oral glucose can counter optic counteract the effects of hypoglycemia an emt can give glucose only by mouth in the form of gel so never administer oral medication to an unconscious patient or to one who is unable to swallow or protect his own airway all right so another oil medication that we could prescribe or that we could give is aspirin now aspirin reduces fever it's pain and inflammation however we're only going to give it in the pre-hospital field to inhibit platelet aggregation okay so um which is useful during a potential heart attack so contraindications are hypersensitivity to aspirin a pre-existing liver damage or some type of bleeding disorder or asthma and should not be given to children okay all right sublingual medications now the considerations of these are there are advantages it's easy to talk with awake and alert patients and advise them to place the pill under their tongue absorption rates are relatively quick now the disadvantages of these are any medication placed in the mouth requires consent constant evaluation of their airway okay and it should not be used if the patient is uncooperative or unconscious now nitro is a sublingual medication that we're going to use and many cardiac patients carry fast-acting nitro in it to relieve angina pain so what it does is it increases blood flow by relieving the spasm and causes arteries to dilate by relaxing muscles of the coronary arteries and veins it also relaxes veins throughout the body so that less blood return is returned to the heart and it decreases the workload and it will decrease blood pressure so before administering nitro we have to check the blood pressure okay and then we need to obtain orders or follow your local protocols to administer nitro it can have a potentially fader interactions with erectile dysfunction medication taken within the last 24 hours and these medications include viagra cialis levitro or drugs for any drug for erectile dysfunction may be shown and it can be used by both men and women in case because erectile dysfunction medications are vasodilators as well and um so because nitro is a vasodilator if you add two vasodilators together you could have a potentially fatal interaction all right so nitro it can be administered by a metered dose spray or by a tablet okay so let's talk about the tablet first you place the tablet under the tongue and it dissolves so the patient should experience a slight tingling or burning sensation nitro should be stored in its original glass container with the cap screwed tightly okay and administered by a meter to spray so deposit we're going to deposit the medication under the tongue one spray equals one tablet administration can considerations for both the tabloid and spray we want to wait five minutes for a response before repeating the dose we need to closely monitor the patient's vital signs particularly the blood pressure and then give repeated doses per medical control or local protocol we want to always wear gloves the medication can be absorbed by your skin and reconfirm the medication is still indicated for the patient know and understand local protocols all right so now we've moved on from sublingual we're going to go to intramuscular medications and the considerations for these there are advantages and they provide quick and easy access to the circulatory system without the need for placing a needle into the vein and blood flow to the muscles is relatively stable even during circumstances of severe illness and injury but there are disadvantages and that is that you have to use a needle and there is some pain involved okay and so the intramuscular medication we're going to use is the epi and this is also known as adrenaline and it releases inside the body when there is sudden stress okay so the main hormone that controls the body's fight-or-flight response and so characteristics is secreted naturally by the adrenal glands it dilates passages in the lungs constricts blood vessels and causes increased blood pressure it also increases heart rate and the blood pressure okay it should be given only to patients who are experiencing a life-threatening allergic reaction so epi may be just dispensed through an auto-injector automatically delivers a pre-set amount of medication and that's usually 0.3 milligrams and some services do not permit emts to carry epi but they do allow them to assist patients in administering their own okay oh and then there it we are going to talk about an intramuscle medication on narcan or naloxone and so there are im injections but there are also intranasal or narcan so probably talk about that next but um first we'll talk about the im and so this is used to reverse the effects of an opiate overdose it can be administered by a family member caregiver so some considerations we need to follow the local protocol of course and find out if naloxone has been administered by a bystander prior to arrival the effects of naloxone may not last as long as the opiates so repeated doses may be needed administration of naloxone to opiate dependent patients can cause severe withdrawal symptoms including seizures and cardiac arrest so consider your personal safety all right and then the next of course is that intranasal naloxone and also called narcan the most common technique for naloxone administration is via the intranasal route the same considerations described for administering the i n or i m naloxone apply here if naloxone is not available we're just going to bag valve mask may be required okay all right inhaled medications the ones we're going to use most often of course are oxygen by far the most commonly administered medication in the pre-hospital setting all cells especially those in the heart and brain need oxygen to function properly and it's generally administered via a non-rebreather mask at 10 to 15 meters or a nasal cannula at six two to six liters most also must also provide artificial ventilations if the patient's not breathing so using a bvm at 15 liters we're going to ensure that there's no open flame lit cigarettes or sparks in the area when we're administering oxygen okay all right now meter dose inhalers and nebulizers so used to administer liquid medications that have been uh turned into a fine mist and by flow of air oxygen so medication is atomized it's breathed into the lungs and delivered to the alveoli and the advantages are its face it's fast and relatively easy to uh route to excess the disadvantages though is the patient needs to be cooperative and controlled breathing they cannot be used for unconscious patients okay so medications administered using a meter disinhaler or small volume nebulizer svn um you an mdi requires a great deal of coordination to administer so may be difficult to achieve when a person is having trouble breathing all right and then there's the spacer for the meter disc inhaler so a spacer fits over the inhaler like a sleeve a spacer has an opening for the inhaler at one end and the mouthpiece at the other the patient sprays the prescription dose into the chamber and then breathes in and out of the mouthpiece until the mist is completely inhaled so spacer devices are especially useful with young children with difficulty using a metered dose inhaler okay so sv ends are much easier to use than meter dose inhalers and that small volume nebulizer they take longer to deliver the medication they require an external air or oxygen source they can be effective then they can be more effective than a meteor disinhaler in patients with moderate to severe respiratory distress and they can be used while the patient is on cpap and during bag valve mask ventilation so they can be easily adapted to a non-root breather mask okay so let's talk about the patient's medications so patients medication so patient assisted includes finding out what with which medication the patient is currently taking this information may provide vital clues to the patient's condition so they may help guide your treatment and may be extremely useful to the emergency department physician and it can help you determine a chronic or underlying condition when a patient is unable to relate his or her medical history so discover what the patient takes and transport the medications or list of them with the patient to the emergency department ask about the use of non-prescription drugs such as over-the-counters or herbal or illegal drugs implications for ems providers do not underestimate the importance of obtaining a thorough medical history medications are frequently not taken or prescribed so consider a patient's medication in the context of the clinical encounter patient medications may significantly alter the clinical presentation of many acute medical problems or injuries okay so you have beta adrenergic blocking agents and calcium channel blockers those can slow the heart rates down of course you have anti-platelet and anticoagulant medications so if a patient even bumps their head they can have significant bleeding in the brain all right so so never underestimate the medications that a patient is taking medication errors is what we're going to talk about next so a medication area is inappropriate use of a medication that could lead to patient harm so ensure that the environment does not contribute to these areas or era sorry and ensure that the lighting is sufficient organize the equipment limit distractions as much as possible and consider using a cheat sheet to help yourself remember all the critical steps to medication administration if a medication error does take place rapidly provide any appropriate care that is required okay so notify medical control as quickly as possible follow your local protocols and document the incident thoroughly accurately and honestly talk with your partner supervisor or medical director this is an opportunity to learn identify areas to target during quality improvement all right so that concludes chapter 12 uh pharm ecology chapter and next we're going to just go through the review slides okay so pharmacology is defined as the what is it it's the field of science that deals with the study of drugs and medications which of the following statements regarding medications is false okay so false and we know it's over-the-counter drugs must be prescribed by a physician nope over-the-counter does not need a prescription which of the following routes of medication administration is the fastest all right so we know that oral is going to be the slowest and that iv you should have said iv iv is the fastest okay it's directly into the vein right into the bloodstream okay when administered to a patient a metered dose inhaler will well it looks like a is the very first one deliver the same dose each time it's administered that's why it's called a meter dose okay you're managing a 62 year old woman who complains of crushing chest pain the blood pressure is 84 over 64. her heart rate is 110 medical control advises you to assist her in taking her nitro what after receiving this order what should you do what should we do all right we're going to repeat the patient's blood pressure to the physician and confirm the order that's what i would do yeah because hopefully the physician heard it in the first place if not he's definitely going to hear it again b all right activated charcoal is indicated for patients who have ingested certain drugs and toxins because well goodness we didn't even really talk about activated charcoal it seems like they left it out of the slide um presentation so activated charcoal is indicated for patients who have ingested certain drugs and toxins because it it's going to bind to chemicals in the stomach and delay the absorption so d okay and we take this for overdoses it's an oral medication and it's charcoal with regard to pharmacology the term action refers to what do we know what action is action is as it implies to pharmacology the term action refers to the effect that the drug is expected to have on the patient's body okay so it is d which of the following patients is best candidate for oral glucose all right so this is a good question it's one that they ask on the national registry questions and you have to be very careful okay so we know right away unconscious we're not going to be doing that one you cannot administer oral glucose for unconscious all right conscious patient who is showing signs of hypoglycemia well that seems very um good answer we're not giving it for hyper and we're not giving it to a semi-conscious so conscious patient who's showing signs of hypoglycemia and that's a all right epi is given to patients with anaphylactic shock because of its effects on so what does it do it bronchodilates and it vasoconstricts we want the bronchioles open and then we want the vessels constricted right to increase the blood pressure perfect two major um complications associated with anaphylaxis shock or bronchoconstriction and then a vasodilation so we want to do the exact opposite very good okay the process by which medications travel to the body until they reach the bloodstream is called and it is the uh ab absorption absorption of adsorption refers to the binding of one chemical to another so it's absorption okay so we'll see thank you for joining me for chapter 12 the pharmacology chapter and if you liked this lecture go ahead and subscribe and we will be doing the rest of the book have a great night