Overview
This lecture covers EMT-level pharmacology, focusing on the “six rights” of medication administration and ten commonly used emergency medications: actions, indications, contraindications, supply, and doses.
Six Rights of Medication Administration
- Six rights ensure safe, accurate medication administration and reduce potential patient harm.
- Apply across all healthcare settings (ambulance, ER, hospital), not only EMS.
| Right | What to Check | Key Details / Examples |
|---|
| Right documentation | Record what was given | Time, route, amount, medication name, patient verification; done during or after call. |
| Right time | Timing of dose | When patient last received it; follow written or verbal physician orders on timing. |
| Right route | How it is given | Oral, sublingual, IM, IV, IO, nebulized, etc.; must match order. |
| Right amount / dose | Quantity given | Verify concentration and volume; double-check with partner (e.g., Epi 0.3 mg vs 0.15 mg). |
| Right medication | Correct drug | Check name, label, packaging, and expiration; many drugs look/sound alike. |
| Right patient | Correct recipient | Verify first and last name and date of birth; especially important when multiple patients. |
Aspirin (Acetylsalicylic Acid, ASA)
- Trade name: Aspirin
- Classification: Antipyretic, analgesic, anti-platelet aggregation agent (“anti-sticky”)
- Key actions:
- Decreases fever (antipyretic)
- Decreases pain (analgesic)
- Prevents formation of new clots (anti-platelet aggregation)
Indications
- Chest pain suggestive of acute myocardial infarction (AMI) / cardiac-origin chest pain.
Contraindications
- Any active bleeding or bleeding disorders.
- Trauma patients with potential internal bleeding (e.g., chest trauma).
Supply and Dose
- Supplied as:
- 325 mg tablets (typical home tablets)
- 81 mg chewable “children’s” tablets
- EMT dose:
- 4 Ă— 81 mg chewable tablets
- Total: 324 mg PO (by mouth), chewed.
Albuterol (Albuterol Sulfate)
- Trade name: Albuterol (also Proventil, Ventolin)
- Classification: Sympathomimetic bronchodilator
- Key actions:
- Stimulates sympathetic nervous system.
- Acts on beta-2 receptor sites in lungs.
- Relaxes bronchial smooth muscle → bronchodilation.
- Decreases airway resistance and relieves bronchospasm.
Indications
- Bronchospasm with wheezing:
- Asthma exacerbation.
- COPD exacerbation with bronchospasm.
- Any condition causing wheezing (bronchospasm).
Contraindications
- Tachycardia (already elevated heart rate), because drug further increases heart rate.
Common Side Effects
- Tachycardia.
- Anxiety, restlessness.
- Hypertension (due to sympathetic response and vasoconstriction).
Supply and Dose
| Form | Supply | Dose | Route / Notes |
|---|
| Metered-dose inhaler (MDI) | Canister with set puffs | 1–2 inhalations | Inhaled via patient’s inhaler, if prescribed. |
| Nebulizer solution | 2.5 mg in 3 mL solution | 2.5 mg | Nebulized at 8 L/min oxygen via small-volume nebulizer. |
Diphenhydramine (Benadryl)
- Trade name: Benadryl
- Classification: Antihistamine
- Key actions:
- Blocks histamine effects released during allergic reactions.
Indications
- Allergic reactions, including rash (urticaria).
Common Side Effects
- Drowsiness.
- Dizziness.
- Confusion.
- Dry mouth.
Dose
Epinephrine (Epi)
- Common name: Epi
- Classification: Sympathomimetic
- Key actions (receptor-specific):
- Beta-1: Increases heart contractility (stronger contractions).
- Beta-2: Causes bronchodilation.
- Alpha: Causes peripheral vasoconstriction.
Indications
Contraindications
- None for anaphylaxis in this context.
Common Side Effects
- Anxiety.
- Tachycardia.
- Hypertension (HTN).
- Nausea, vomiting.
Supply and Dose
| Patient | Concentration | Dose | Route | Note |
|---|
| Adult | 1:1000 | 0.3 mg | IM | For anaphylaxis. |
| Pediatric | 1:1000 | 0.15 mg | IM | Half adult dose. |
- Important: Use 1:1000 for anaphylaxis, not 1:10,000.
Glucagon
- Name: Glucagon (both trade and generic)
- Classification: Pancreatic hormone
- Key actions:
- Increases blood glucose by stimulating glycogenolysis:
- Converts stored glycogen back to glucose.
- Stimulates gluconeogenesis:
- Promotes glucose metabolism in liver and increases usable blood glucose.
Indications
- Hypoglycemia, especially in unresponsive patients who cannot take oral glucose.
Contraindications
- None specified in this lecture for EMS use.
Dose
Oral Glucose
- Classification: Simple sugar (monosaccharide)
- Key actions:
- Increases blood glucose level (BGL).
Indications
- Blood glucose less than 70 mg/dL.
- Altered mental status.
- Ability to swallow safely.
Contraindications
- Blood glucose greater than 70 mg/dL.
- Unresponsive patient or inability to swallow (risk of choking and airway compromise).
Side Effects
- Generally none if given properly; possible mild nausea.
Dose
- 1 tube = 15 grams PO.
- Only medication in this list measured in grams instead of milligrams.
Ipratropium Bromide (Atrovent)
- Also called: Ipratropium bromide, Atrovent
- Classification: Anticholinergic
- Key actions:
- Used as bronchodilator; often combined with albuterol.
Indications
- Bronchospasm, similar to albuterol:
- Bronchial asthma.
- Anaphylaxis with bronchospasm.
- Burns or toxic inhalations causing bronchospasm.
- COPD exacerbation.
- Commonly combined with albuterol in a “DuoNeb.”
Contraindications
- Allergy to peanuts.
- Allergy to soybeans.
Supply and Dose
| Drug | Concentration | Volume | Dose | Route |
|---|
| Ipratropium bromide | 0.5 mg | 2.5 mL solution | 0.5 mg | Nebulizer (entire container) |
Naloxone (Narcan)
- Generic: Naloxone
- Trade/common: Narcan
- Key actions:
- Competitively binds opioid receptor sites.
- Displaces narcotics and synthetic narcotics from receptors.
- Antagonizes all actions of narcotics without producing narcotic effects.
Mechanism Concept
- Opioid receptors = receptor sites where narcotic molecules bind and cause CNS depression, bradypnea, etc.
- Naloxone has higher affinity:
- Kicks narcotic off receptor.
- Occupies receptor without narcotic effects.
- Reverses respiratory and CNS depression.
- Narcan has shorter duration of action than many opioids:
- Patient can re-sedate as Narcan wears off.
- May require repeated doses.
Indications
- Complete or partial reversal of narcotic-induced depression:
- Suspected opioid overdose with:
- Unresponsiveness.
- Pinpoint pupils.
Dose
| Initial Dose | Route | Repeat | Maximum Total |
|---|
| 2 mg | Intranasal (IN) | PRN, as needed | Up to 10 mg (5 doses of 2 mg) |
- Distribution between nostrils (1 mg each or 2 mg in one) depends on packaging, but total initial dose is 2 mg.
Nitroglycerin (Nitro)
- Generic: Nitroglycerin
- Common name: Nitro
- Classification: Nitrate, vasodilator
- Key actions:
- Causes vasodilation, especially coronary arteries.
- Reduces myocardial workload.
- Decreases myocardial oxygen demand.
- Increases perfusion to ischemic myocardium.
Indications
- Chest pain of cardiac origin:
- Angina.
- Suspected AMI-related chest pain.
- Not for traumatic chest pain or internal bleeding.
Contraindications
- Recent use of erectile dysfunction (ED) medications:
- Within last 24–48 hours.
- Examples: Viagra, Cialis, Levitra, others.
- Hypotension:
- Systolic blood pressure less than 100 mmHg (some sources use <90, but 100 used here).
- Head injury with increased intracranial pressure (ICP).
Supply and Dose
| Form | Single Unit | Dose | Route | Frequency |
|---|
| Spray | 0.4 mg per spray | 0.4 mg | Sublingual | Every 3–5 minutes if SBP ≥ 100 |
| Tablet | 0.4 mg per tablet | 0.4 mg | Sublingual | Every 3–5 minutes if SBP ≥ 100 |
- EMTs use spray or tablets, not paste.
Ondansetron (Zofran, Zofran ODT)
- Generic: Ondansetron
- Trade/common: Zofran ODT (orally dissolving tablet)
- Classification: Anti-emetic
- Key actions:
- Anti-vomiting drug; acts on serotonin receptors (details not emphasized here).
Indications
- Moderate to severe nausea and vomiting.
Supply and Dose
| Form | Tablet Strength | Total Dose | Administration |
|---|
| Zofran ODT | 4 mg tablet | 8 mg total | 2 tablets PO once (orally dissolving) |
Key Terms & Definitions
- Antipyretic: Drug that reduces fever.
- Analgesic: Drug that reduces pain.
- Anti-platelet aggregation: Drug that prevents platelets from clumping and forming new clots.
- Bronchodilation: Widening of bronchial airways by relaxing smooth muscle.
- Bronchospasm: Constriction of airway smooth muscle, causing wheezing and difficulty breathing.
- Sympathomimetic: Drug that mimics the sympathetic (fight-or-flight) nervous system.
- Antihistamine: Drug that blocks histamine effects during allergic reactions.
- Anticholinergic: Drug that blocks acetylcholine activity; here used as bronchodilator.
- Hypoglycemia: Abnormally low blood glucose level.
- Glycogenolysis: Breakdown of glycogen to glucose.
- Gluconeogenesis: Production/metabolism of glucose in the liver for use.
- Monosaccharide: Simple sugar unit (e.g., glucose).
- Opiate / opioid receptor: Site in the body where narcotics bind to exert their effects.
- Anti-emetic: Drug that prevents or reduces nausea and vomiting.
- PO (per os): By mouth.
- IM: Intramuscular.
- IN: Intranasal.
- SL (sublingual): Under the tongue.
- ICP: Intracranial pressure.
- BGL: Blood glucose level.
- HTN: Hypertension (high blood pressure).
Action Items / Next Steps
- Memorize for all 10 drugs:
- Trade name.
- Classification.
- Mechanism/action.
- Indications and contraindications.
- How supplied and typical EMS dose.
- Common side effects.
- Practice applying medications to patient scenarios:
- Match signs/symptoms to correct drug and dose.
- Check six rights for every scenario.
- Review protocols and medication math:
- Distinguish similar doses (e.g., Epi 0.3 vs 0.15 mg).
- Confirm correct concentration (1:1000 vs 1:10,000).
- Revisit notes regularly to build speed and accuracy in field decision-making.