hi it's john from jacksonville again and today we're going to do chapter 12 principles of pharmacology again you have to have a fundamental knowledge of the medications that an emt is going to administer or assist the patient in taking during an emergency we talk about the principles of pharmacology there's medication safety and the kinds of medications used during an emergency some of the medications are going to be self-administered some could be peer administered and sometimes we assist in the administration of the medication to the patient so with the emergency medications there's the names the effects the actions the indications and the contraindications truly as an emt you should know all of these medications that you can give or assist in giving and you should know all these aspects of that medication especially the indications and contraindications sometimes the complications of the medication routes of administration oh my gosh i've had so many people administer medications wrong when we've done our skills day so please please please pay attention on how to administer these medications the side effects the interactions and the doses you have to know all of these parts of medications so again medication or important intervention help they may help alleviate pain improve your patient's condition failure to administer medication safely and competently can lead to serious complications to the patient including death that's crazy to think about pharmacology is a science of drugs a medication is a substance used to prevent or treat a disease or relieve pain and then the pharmacodynamics is a process by which the medication works on the body agonist causes stimulation of receptors antagonist binds to the receptor and blocks other medications or chemicals the dose is the amount of the drug or medication given and the action is the therapeutic effect that the medication is expected to have on the body pharmacokinetics again the actions on the body depend on the medication or chemical the onset the duration these are all very important things to consider even at the emt level when you're giving medications the elimination and the peak performance of that drug factors affecting how the medication works are are considered the route of administration and shock states indications are the reasons or conditions you would use that medication contraindications are the harmful effects whether they're the absolute relative contraindication and the adverse effects even if it has is you use the medication properly it could have adverse effects either they're unintended or untoward effects so the the generic name is the simple clear non-proprietary name for example ibuprofen the trade name is the name the manufacturer gives it so the example would be tylenol that's a trade name versus a generic name which is ibuprofen we have prescription medication medicines we have over-the-counter medicines recreational drugs herbal remedies enhancement drugs vitamins and even alternative medicines so there's all kinds of different medications out there on the market but we always typically think of prescription over-the-counter and the recreational drugs entero medications enter the body through the digestive system and parenteral medications enter the body by some other means absorption is a process by which the medicine travels through the body tissues to the bloodstream so some of the common routes for this administration that's absorbed through the tissues is by the mouth po or rectum there are medications that we can give actually rectally common routes of administration are iv through the vein i o which is interosseous through the bone sc or subcutaneous which is just below the skin and intramuscular intramuscular i am into the muscle now as an emt you can't do all of these you can do the im especially when we get into the epinephrine auto injector you can also inhale the drug in which you can assist with people with having breathing difficulties sublingually which means it goes under the tongue transcontanius or transdermal that's like a patch that's put on the skin and then intranasally anything we squirt up the nose so if you look at this table of absorption routes so if we give something through sublingual under the tongue it's a rapid absorption or in the rectum it's rapid if you do it by mouth it's slow ib and io it's almost immediate inhalation intranasally is rapid i am again is kind of moderate speed and then subcutaneously or transcutaneously it's going to be a slow absorption so this does come into effect even at the emt level when we talk about the medications we can give so the form of the medication usually dictates which way we're going to or which route we're going to use to administer the medication the manufacturer turn chooses the form to ensure proper route timing of the medications release into the bloodstream and the effects on the targeted organs or body systems capsules or gelatin filled are filled with powder or liquid and they often contain material that are mixed with medication and compressed that's a that's a tablet is is compressed like an aspirin tablet and a capsule would be kind of like a tylenol where we have the medication inside that gelatin shell that dissolves solutions or in suspensions so a solution is a liquid mixture again that's not separated by filtering or letting it stand still but it can be given iv im or sub q again those are things that one of them we can do with the im a suspension is a substance that does not dissolve well in liquids and it will separate if it stands or it's filtered meter dose inhaler the mdi again liquids or solids broken into small droplets or particles and then they're inhaled this is what we use if someone is having an asthma attack and they're having a breathing difficulties and then we can help administer or we can administer this meter dose inhaler topical lotions creams and ointments uh really there's none of those that at the emt level we can administer but we think about things like calamine lotion that that kind of pinky kind of substance that cream like a hydrocortisone cream for an allergic reaction or an ointment like neosporin for like you'd put on a cut or something transcontanious medications they're absorbed through the skin uh it's also referred to as transdermal again if you touch the substance or medication with your skin you can absorb it just like the patient so the one that comes to mind typically is with our cancer patients having a patch called like a fentanyl patch fentanyl is a very strong pain medication that's on a patch and you place it on their skin that's absorbed into their skin to help with the pain from their cancer again if you touch it with their bare hand you too could get the effects of that medication gels it's a semi liquid it's administered in capsules or through plastic tubes oral glucose for diabetic is a gel gases uh again non-rebreathing mass nasal cannula oxygen is what we're talking about a lot of people forget that oxygen is a medication so there's general steps before you can administer a medication first off the medication should only be administered under authorization medical control typically emts have to call for permission to give a medication anything other than oxygen they typically have to call and get permission for and then there's certain rights for medication administration and then medication errors almost always follow the failure to follow one of those rights so the rights are you use you get the right patient you have the right medication for the right indication the right dose the right route the right time your textbook even talks about the right education your patient has the right to refuse you have the right response and evaluation in the right documentation if you don't document that you gave your patient oxygen two years down the road when you're testifying in court over your run report and they say did you give your patient oxygen and you say yes i give oxygen to all my patients well you didn't put it in this your patient care report so if you don't have it in that patient care report there's no proof that you actually gave that person oxygen you have to have the right documentation when i ran my paramedic program in indiana i told my paramedic students this that if you have not made a medication error yet you will and it happens a lot uh and hopefully it's not going to have any serious effects on our our patients but if you haven't made an error you probably will sometime in your life in your career so medications uh and the emt so circumstances in which medications may be administered peer assessed medic administration patient assisted and the emt administered so brother and sister friends can administer medications or the patient uh we can assist them in taking it again it's determined by your state and local protocols and medical control there are certain medications that you're allowed to give with permission and they're certain and in other areas you make only assist them in taking their medication so it's kind of complicated but it really does depend on where you are performing as an emt so oral medications again with aspirin we're going to be using aspirin and we're gonna give it orally but with aspen we're gonna have them chew it up so that it's absorbed faster so when you give a patient aspen for chest pain we'll say we're not gonna give it for a headache we're giving them aspirin for chest pain [Music] and with that aspirin administration we're going to have that patient chew up the aspirin so that it's absorbed faster with oral glucose again we're going to give our patient uh oral glucose if they're low on their sugar it this is for treating hypoglycemia or low blood sugar we give it by mouth and we never give it to an unconscious patient or one who cannot protect their airway now when we talk about giving oral glucose by mouth we don't stick the tube in their mouth and they eat it to it swallow it it needs to be swabbed on the inside of their cheeks so it's absorbed faster into their the muco linings of their mouth not under their tongue and not like eating a candy bar aspirin we used to maybe your patient is using it to reduce their fever their pain or inflammation we use it in people who are having chest pain for a possible heart attack now people think that aspirin r is a uh a blood thinner and it's not it inhibits platelet aggregation in other words if you're having chest pain and a possible heart attack it's because there's a blockage somewhere that you have a blockage building up what aspirin does is it helps that blockage from getting any bigger it doesn't thin your blood it helps the blood from coagulating or clotting and making that clot bigger but there are contraindications to aspirin such as bleeding disorders hypersensitive to aspirin people can have an allergy to aspirin or allergic reaction to aspirin and again we're not going to give it to children sublingual medication this is something that goes under the tongue uh it's easy to tell people you just lift your tongue you give the medication and it's absorbed quickly in the mouth the disadvantage is you have to evaluate the airway they might choke and and again if they're not cooperative if they're unconscious it's not going to work nitroglycerin is one medication that we're going to give sublingually under the tongue and on the right side there's either a spray or a tablet and either way it's the same dose it doesn't matter one spray or one tablet is the same dose and what nitroglycerin does it relieves chest pain for those people that might be having a heart attack it helps the increase of blood flow and it relaxes the veins uh in arteries kind of it kind of opens up the pipes a little bit bigger in your cardiovascular system so that we have more blood going to the heart a heart attack is a blockage of blood to the muscle of the heart and we want to get as much blood and oxygen to that blockage as we can before you administer you have to check the blood pressure and obtain an order to administer nitroglycerin because there are some contraindications the possibility of an mi if there's no relief you should not be using this medication in conjunction with any erectile dysfunction medications 24 to 48 hours prior they cannot have taken any erectile dysfunction medications they talk about when even if you administer it one of the common side effects for nitroglycerin is a headache we give it by tongue under the we just have them lift their tongue there might be a slight tingling or burning sensation storage of this medication is important and if you go let me go back a couple slides if you look at the the containers that nitroglycerin comes in they're colored there's a brown glass for the tablets and there's kind of like a red plastic for the spray that's important because sunlight will degrade uh the effectiveness of nitroglycerin so that's why they're in these protected containers so let's go back on here administration by the meter doe spray on or under we typically still do under the tongue one spray equals one tablet again common side effect headache considerations wait five minutes before you give that medication again and before you give any medication you need to check the vital signs especially if you're giving this medication by tablet wear your gloves you should be wearing your gloves all the time anyway but you don't want to get this medication on your skin because you can receive the same effects of that medication intramuscular injection the im again the advantage of this uh delivery system is to quick and easy access without finding a vein so we don't need the paramedics to do this there's a stable flow of blood to your muscles so that blood is going to help distribute that medication the disadvantage is the use of a needle okay we don't think it's a big deal but there's a lot of people who have needle fears and that the pain is the thing that they're thinking about epinephrine this is the one medication we can give i am or inner muscularly it controls that fight or flight response it's delivered i am another name for epinephrine is adrenaline and it's released in the body under stress and it's sympathomimetic as this is the type of medication it is so it increases your heart rate and constricts blood vessels it do not give this to patients with hypertension hypothermia a myocardial infarction or any wheezing so again epinephrine is only going to be used for our circumstances for allergic reactions naloxone another name for naloxone is narcan everybody knows narcan it's a crazy world that we're in that everybody knows what narcan is even people who aren't educated in medical science so it's used to reverse the effects of an opioid overdose only we need to consult medical control the effects may not last as long as the opioids so you might have to do repeated doses you can cause severe withdrawal syndromes and then think about your safety so when you give narcan and we give it only if they're an opioid overdose it only works on opioid overdoses doesn't work on cocaine or methamphetamine it only works on opioids you give this because their their respirations have slowed down and when you get the medication it kind of blocks that medication that's an antagonist it blocks the receptor so the the drug the opioid doesn't work so once that is blocked your patient has a couple different responses when they come out of their their drug induced stupor is they basically will either start vomiting um they'll start fighting uh they'll be very confused of what's happening and they just won't know what's happening so given narcan or naloxone the most common ways up the nose because it's really a fast it's effective there's no needles or anything necessary we just squirted up their nose i could squirt it up your nose right now you would hardly even know that it's in your body it's not going to do a thing to you only if you're on opioids the funny part is after you always give this you say you ask your patient what they took 9 out of 10 times they're going to tell you they don't do drugs they've never taken drugs they don't know what you're talking about the funny thing is this only works on opioid overdoses only that has to be what is in your system or else it wouldn't have worked oxygen is a medication we've talked about that in in uh airway management lecture uh all cells need oxygen to survive we give it by a non-rebreather or nasal cannula typically meter dose inhalers and nebulizers are the same medication it's a butyrole and we can either give it through a metered dose inhaler or we can pour this medication into a little cup hook an oxygen tube to that cup and it makes that medication transform into a mist and then the this fine mist is basically inhaled by our patient it's really faster and as an emt you're able to administer medications this way if you're using the meter dose inhaler sometimes people will have a spacer and this spacer is there to when you squirt the medication into that spacer and then they breathe the medication it helps keep the medicine in the person sometimes you know if they don't put their lips around the mdi it bounces off or doesn't they don't get the full effect uh it's it's this helps um deliver the medication better uh by using this uh spacer device again the metered dose excuse me the nebulizer uh it's easier to use it takes longer because you're going to be breathing this medication and it's going to take longer but it really is more effective again even as an emt we can help them take this medication by this nebulizer patient assessment includes finding out which medication the patient is taking because we just don't want to make sure that are we sure we want to make sure that the medications don't have an adverse effect of the other medications that they might be on do not underestimate the importance of obtaining a thorough medical history even if you know the medication to give to your patient is let's say oral glucose you want to make sure you get a thorough medication history before you give any medication medications are often not taken as prescribed sometimes if the medication costs too much and they only instead of taking it every day they take it every second day or third day maybe they took too much they thought well if one helps maybe i'll take two so a lot of people don't take medications like they're prescribed and it might alter their clinical presentation inappropriate use of medication could lead to patient harm so it might be possible to minimize errors and circumstances if circumstances are understood and ensure the environment does not contribute to errors don't let people rush you to make a decision on your medication administration if a medication error occurs if you give the medication wrong or you gave them the wrong medication notify medical control document everything that you did and you have to be honest do not cover it up if you try to cover it up you're gonna lose your emt uh license or certification and you're gonna be out there's no place in ems for lying about medication errors so pharmacology is defined as the study of cells and tissues study of drugs effects of medication or the distribution of drugs pharmacology hopefully this is an easy one it's the be study of drugs and medications uh cells and tissue that's uh it's part of biology we have physiology uh the medications or the effects of the medication is pharmacodynamics and the distribution is pharmacokinetics which are the following statements regarding medications as false many medications are known by different names some medications affect more than one body system over-the-counter drugs must be prescribed by a physician an emt should ask about any herbal remedies or vitamins that the patient might be taking i really hope that one stuck out to you to see over the counter like tylenol motrin all that stuff does not need to be prescribed three which of the following rows of medication and administration has the fastest effect oral intravenous subcutaneously or inter-muscular not not the fastest route that an emt can administer but the fastest overall route yep iv that's where the paramedics come in and they start the drug they start an iv catheter and they push the medication through the vein and that's going to be the fastest way to get a medication into the system number four when administered to a patient a metered dose inhaler will deliver the same dose each time be ineffective when given to a patient with asthma will deliver a different dose each time or be delivered to the lungs over a period of six to eight hours when administered to a patient a metered dose inhaler will yup a same dose every time that's how it's designed so with a metered dose inhaler when you when you do use it you're going to take it you're going to shake it up because it's a powder in there and once you shake it up real good then we administer it you're managing a 62 year old woman who complains of chest pain crushing chest pain her blood pressure is 84 over 64. her heart rate is 110 beats per minute medical control advises you to assist her in taking her prescribed nitroglycerin after receiving this order you should reassess the heart rate and give the nitro repeat the blood pressure to the physician and confirm the order wait 10 minutes reassess the blood pressure and give the nitro or administer the nitroglycerin to a patient and then reassess blood pressure if you look at the contra indications for giving nitroglycerin one of the contraindications is hypotension we need a blood pressure over 90 millimeters of mercury systolic so we have to make sure we have a blood well sorry your book says a hundred millimeters so you can't give a systolic if you have a systolic blood pressure less than a hundred there are other resources out there that talk about 90s for our paramedic friends so 100 for your emt textbook sorry so when you give nitroglycerin it's going to lower the blood pressure because it dilates the blood vessels so we want to again tell repeat to the physician so that they hear what we have for a blood pressure and confirm they still want us to give it make sure the physician is aware maybe they didn't catch your number maybe they didn't hear it they're doing something else activated charcoal is indicated for patients who have ingested certain drugs and toxins because it acts as a direct reversal agent it induces vomiting detoxifies the drug or binds to chemicals in the stomach and delays absorption if you have a first aid kit at home you probably have something in there if you do it's a little bottle liquid bottle and it has in it syrup of ipac and that is used to induce vomiting so it's not that activated charcoal is used to bind with chemicals before they enter your body um it's not a reversal agent it doesn't make you vomit uh you know it does taste horrible uh it doesn't detoxify the drug it just binds to it so then we can get rid of that that medication or that that drug with regard to pharma pharmacology the term action refers to the ability of the drug to cause harm the ability of the drug to produce side effects amount of time it takes or will take for the drug to work or the expected effect of a drug on the patient's body that's a good one action it is d action refers to the effect that we want the drug to give to the patient onset of action is the time um again the ability of drug produced side effects any medication can do that and the ability of a drug to cause harm that's a contra indication which of the following patients is the best candidate for oral glucose so a conscious patient showing signs of hypoglycemia an unconscious diabetic patient with documented low blood sugar a conscious diabetic patient suspected of being hyper glycemic a semi-conscious patient with signs and symptoms of low blood sugar so when can we give oral glucose well the first one that's out is we don't give it to somebody who's unconscious and we obviously on c don't give it to somebody who has hyperglycemia or high blood sugar so it's either a or d it's a they have to be conscious not semi-conscious uh again if they're not able to chew and swallow uh they might kind of gag on that or they might inhale that medication into their lungs where we don't want it or they might start vomiting nine epinephrine is given to patients with anaphylactic shock because of the effects of bronchodilation and vasodilation that's opening up the pipes bronchodilation and vasoconstriction so it opens up the airway but closes off your your uh your vascular system vasodilation and bronchoconstriction so it opens up your blood pathway and closes and restricts your breathing pathway and bronchoconstriction and vasoconstriction where it shuts everything down what do you think b it is the um again it's going to open up your airway and close off the your your vascular system epinephrine is given to patients obviously when they're enough allergic reaction anaphylaxis they can't breathe and and the pipes have gotten big so we need to close down their their blood vessels and open up the pipes to their lungs so the last question is going to be the process by which medications travel through body tissues until they reach the bloodstream is called absorption onset of action the first one is adsorption c is absorption so just trying to pronounce those words and the last one is transformation so is it adsorption onset of action absorption or transformation process which medications travel through the body tissues until they reach their bloodstream that is called sorry i gotta click here c absorption uh it's the binding of the chemical to another uh that kind of stuff adsorption particles bind to a surface onset of action is the time that it takes for the medication to start doing what it's prescribed for absorption is traveling through the body tissue until they reach the bloodstream and transformation that has nothing to do with medical administration at all medicine administration so that is pharmacology