EMR Chapter 22 - Pharmacology

What is Pharmacology?

Pharmacology is the study of drugs and how they interact with the body.

What are Indications to administration?

Conditions that make administration of the drug appropriate.

What are Contraindications to administration?

Conditions that make administration of the drug inappropriate due to potential harmful effects.

What are Side effects to administration?

Any reactions to the drug other than its intended effects. For example, a drug intended to reduce pain may also cause nausea.

Can a lifesaving drug be indicated even if there are potential serious negative side effects?

Yes, the benefits of the desired effects are weighed against the risks of complications

What are Protocols?

Protocols allow the responder to perform medical procedures that are normally in the domain of a physician. This allows responders to initiate care that patients would otherwise not receive until they arrived at a medical facility.

What is the difference between assisting and administering medication?

Assisting: following a patient’s specific direction to help with medication.

Administering: making the decision to give a medication to a patient and then actually introducing the drug into the patient’s body

What are some examples of assisting with medication?

• Opening the lid of a pill bottle

• Placing pills in a patient’s hand

• Opening an epinephrine autoinjector

• Unwrapping a transdermal patch

• Reading a medication’s label aloud

• Pushing pills out of a blister pack

What are some examples of administering medication?

• Injecting a medication

• Placing medication in a patient’s mouth

• Placing a transdermal patch on a patient’s skin

• Spraying medication into the patient’s nose

When administering or assisting a patient with medication, the responder has a responsibility to know what information?

* therapeutic benefits
* side effects
* indications
* contraindications.
* The responder should use proper technique and monitor the drug’s effects (and side effects).

What are the “Six Rights of Medication”

* Right person
* Right medication
* Right dosage
* Right time
* Right route
* Right documentation

What is the “Right Person” in the “Six Rights of Medication”

Make sure the patient receiving the medication is the one whose name is on the label of the medicine container.

What is the “Right Medication” in the “Six Rights of Medication”

Read the label and confirm the name of the medication.

What is the “Right Dosage” in the “Six Rights of Medication”

Accurately measure the indicated quantity of medication.

What is the “Right Time” in the “Six Rights of Medication”

Give the medication at the right time.

What is the “Right Route” in the “Six Rights of Medication”

Read the directions carefully and administer with the correct method.

What is the “Right Documentation” in the “Six Rights of Medication”

Completely document your actions and findings, including:

• Time

• Dose

• Route

• Effect

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\*\*Best practice includes Vitals before and after

What is Addiction?

A strong dependence on a drug; it may be physiological, psychological, or both, and it may be due to a decreased response to a drug with repeated use.

What are Agonists?

Drugs that bind with a receptor in the body to produce a biological response.

What are Antagonists?

Drugs that combine with a receptor to prevent a biological response.

What is a Contraindication

A medical or physiological factor that makes it harmful to administer a medication that would otherwise have therapeutic value.

What is a Depressant?

A substance that decreases a body function or activity.

What is a Drug Allergy?

A reaction to a drug resulting from previous sensitizing exposure and the development of an immunological mechanism.

What is a Drug Interaction?

A modification, which can be beneficial or detrimental, of the effects of one drug by the administration of another drug.

What is an Indication?

The conditions that make the administration of a drug appropriate.

What is a Potentiation?

An increase in the effect of a drug due to the administration of a second drug.

What is a Side Effect?

An often unavoidable effect of a drug; an effect other than those for which the drug was originally given.

What is Synergism?

The combined effects of two drugs such that the total effect exceeds the sum of the individual effects of each agent (sometimes expressed as “1 + 1 = 3”).

What is a Therapeutic Action?

The desired, intended effect(s) of a drug.

What are the two most important drug names?

Generic and Trade name.

What is a drug’s chemical name?

The scientific name for the drug’s atomic or molecular composition (e.g., the chemical name for Aspirin® is acetylsalicylic acid).

What is a drug’s Generic/non-proprietary name?

An abbreviated form of the chemical name of the drug. Generic medications usually have the same therapeutic efficacy as the non-generic medication and are generally less expensive.

What is a drug’s Trade/Brand/Proprietary name?

A copyrighted name designated by the drug company that develops and requests approval for the medication. Trade names of drugs are considered to be proper nouns and, therefore, the first letter is capitalized (e.g., Demerol).

What is a drug’s Official name?

Followed by the initials “USP” or “NF,” this name denotes the medication’s listing in one of the official publications; it is usually the same as the **generic** name (e.g., meperidine hydrochloride USP).

What is a drug route?

The method of introduction to the patient’s body.

What is an Enteral administration route?

A route through the digestive system.

What are 4 **enteral** administration routes?

* Oral
* Sublingual
* Buccal
* Rectal

What is the Oral route of administration? Why is this concidered slow?

* Drugs are swallowed and absorbed through the digestive system.
* Solid drugs must first dissolve before absorption: The slower absorption rate means the patient must be monitored for a longer period after taking the medication.

What LOC must a patient have to use an Oral drug route?

* The patient must be responsive and able to control his or her own airway.

What is the Sublingual route of administration?

* Medications are delivered under the tongue and are rapidly absorbed into the blood.
* Sublingual drugs are not to be swallowed or inhaled.
* The patient should not take anything else by mouth until the drug is completely absorbed.

What is the Buccal route of administration?

* The drug is placed between the cheek and the gum and is absorbed across mucous membranes.
* This route is not common in a pre-hospital setting.

What is the Rectal route of administration?

* Suppositories are solid at room temperature and dissolve with body heat when placed in the rectum.
* Liquids can be instilled with a syringe.
* This route is not common in a pre-hospital setting.

What are 7 **parenteral** drug administration routes?

* Intravenous / IV
* Endotrachael
* Subcutaneous
* Intradermal / ID
* Instramuscular / IM
* Intranasal / IN
* Inhalation

What is an Parenteral administration route?

A drug route not using the digestive system.

What is the Intravenous/IV route of administration?

* The drug is administered directly into the vein.
* This route requires an IV line to be started (aseptic technique).

What is the Endotracheal route of administration?

* The drug is administered through an Endotrachael (ET) tube.
* This route is only used by ALS practitioners.

What is the Subcutaneous route of administration?

* The drug is administered into the layer of fat between the patient’s muscle and skin.
* This route involves smaller volumes and slower onset than intramuscular (IM) administration.

What is the Intradermal route of administration?

* The drug is administered into the dermis, just below the epidermis.

What is the Intramuscular route of administration?

* The drug is administered directly into a large muscle.
* The drug absorbs well due to the rich blood supply of muscle tissue.
* The volume given must be carefully assessed based on the patient’s size and the site of administration

What is the Intranasal route of administration?

* The drug is administered into the patient’s nostril in mist form.
* This route allows rapid absorption of medication into the bloodstream through the mucous membrane.

What is the Inhalation route of administration?

* Patient must be conscious, and inhale the medication/
* This route produces rapid onset of the effects if the drug reaches the lower airways and passes into general circulation.

What is Pharmacokinetics?

Pharmacokinetics is the study of how the body handles a drug over a period of time.

What are the 4 parts of Pharmacokinetics?

* Drug absorption.
* Drug distribution.
* Biotransformation.
* Excretion.

What is Drug Absorption? (Pharmacokinetics)

Drug Absorption involves the movement of drug molecules from the site of entry into general circulation

What can affect Drug Absorption? (Pharmacokinetics)

Variables that affect drug absorption include:

* Blood flow to the site of administration.
* Solubility of the drug.
* pH of the body.
* Concentration of the drug.
* Route of drug administration

What is Drug Distribution?

Distribution is the transport of a drug through the bloodstream to various tissues of the body and, ultimately, to its site of action.

What variables affect Drug Distribution?

The rate of distribution depends on the permeability of the capillaries to the drug molecules.

Cardiac output and regional blood flow also affect the rate and extent of distribution.

What is Drug Biotransformation?

Biotransformation is the process by which a drug is chemically converted to a metabolite. This detoxifies a drug and renders it less active.

What is the primary site of Drug Metabolism/Biotranformation?

The liver is the primary site of drug metabolism.

What can happen if Drug metabolism is delayed?

Drug accumulation and cumulative drug effects may occur.

What is Drug Excretion?

Excretion is the elimination of toxic or inactive metabolites from the body.

What organs help Drug Excretion?

The organs of excretion include the kidneys, intestines, lungs, sweat glands, salivary glands, and mammary glands.

What are Pharmacodynamics?

Factors that can influence the actions of drugs

What factors can influence the actions of drugs?

“BEGAT PGP”

* Age of patient
* Body mass
* Gender
* Environment
* Time of administration
* Pathological state
* Genetic factors
* Psychological factors

What is the job of the Sympathetic Nervous System?

The SNS prepares the body for stress and emergencies.

What chemical messengers are released by the Sympathetic Nervous System?

Epinephrine is one of the chemical messengers released by the sympathetic nervous system.

What are the three types of receptors in the Sympathetic Nervous System?

* Alpha1 receptors: When stimulated, they cause peripheral vasoconstriction.
* Beta1 receptors: When stimulated, they cause increased heart rate and increased force of cardiac contraction.
* Beta2 receptors: When stimulated, they cause bronchodilation.

What does a peripheral intravenous (IV) line allow to be administered?

IV line’s can be used to introduce medication and fluids directly into a patient’s circulatory system. This includes blood and saline.

What PPE should be worn when working with IV lines?

* Gloves
* Eye protection
* Mask
* Anything else available.

What is an IV Drip set?

A drip set consists of tubing that can connect to the catheter in the patient’s arm on one side and the drip bag on the other.

As part of an IV, what does a Drip Chamber do?

The drip chamber allows you to monitor the rate at which fluid drips ino the line.

As part of an IV, what does a Medication port do?

A medication port that allows other medication to be introduced into the line with a syringe.

As part of an IV, what does a Line lock do?

The drip set also includes a line lock that allows you to adjust the drip rate or suspend the flow entirely.

As part of an IV, what does a Check or Back-flow valve do?

It prevents fluid from moving up the line.

What are commonly used Crystalloid solutions with an IV line?

* Normal saline: a 0.9% sodium chloride solution; an isotonic volume expander
* Dextrose: 3.3% dextrose and 0.3% sodium chloride (2/3 and 1/3)
* Ringer’s lactate: a solution containing sodium chloride, potassium chloride, calcium chloride, and sodium lactate in distilled water
* D5W: 5% dextrose in water

What is the chemical makeup of Normal Saline, and its purpose?

Normal saline is a 0.9% sodium chloride solution; and an isotonic volume expander.

What is in Ringer’s lactate?

It’s a solution containing:

* sodium chloride
* potassium chloride
* calcium chloride
* sodium lactate
* all in distilled water

What are the steps to prepare a Drip Set and Solution?

1. Inspect the solution and packaging before assembly. Check the 6 Rights of Medication.
2. Assemble the drip set and close off the line with the line lock.
3. Hold the solution bag upside down and
remove the protective cap on the port using
aseptic technique.
4. Insert the spiked end of the IV drip chamber into the port with a straight push.
5. Squeeze the drip chamber until it is half to two-thirds full.
6. Release the line lock and purge all air from the line.
7. Confirm that the solution is flowing, then lock off the line.
8. Once IV therapy has been initiated, adjust the drip rate until the correct flow rate is achieved.

What is the unit of messuring IV Flow Rates?

Drops per minute, or gtt/min.

What are the three pieces of information needed for an IV Flow Rate?

* Volume to be infused (in mL)
* gtt/mL of administration set (the size of the drops)
* Total time of infusion (in minutes)

What is the formula to calculate IV Flow Rates?

volume x gtt/mL (drop size)

gtt/min = ------------------------------

time of infusion (in mins)

What is the flow rate of 500mL at 10gtt/mL over one hour?

500 x 10 / 60 = 83.3 gtt/min

What indicates an IV bag needs to be changed?

* The bag is empty or has less than approximately 50 mL remaining inside it.
* You are given instructions from the medical staff that the IV is to be changed en route during a transfer.

When changing an IV bag, what must be noted?

* Time changed
* Amount and solution hung
* Amount and solution discarded

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Ex. 0930 (time) to 1000 mL N/S (Normal Saline) started at 500 mL/hr, 50 mL solution discarded. \[Signature\]

What are some complications of an IV?

* Interstitial IV
* Circulatory Overload
* Thrombosis and Thrombophlebitis
* Catheter Embolism
* Site Infections
* Allergic Reaction
* Air Embolism

What is an Interstitial IV?

If an IV is interstitial, this means that the IV fluid is flowing into the surrounding tissues instead of into the vein due to complete or partial perforation of the vein through the opposite wall.

What are the signs of an Interstitial IV?

* Swelling around the injection site
* Skin is cool to the touch
* Flow rate may be diminished
* Pain may not be present

How do you treat an Interstitial IV?

Once you have identified that the IV is interstitial,
perform the following interventions:


1. Discontinue the IV.
2. Record the time at which the IV was
discontinued and the amount infused.
3. If the swollen area is small, apply a cold pack.
4. If the swollen area is large, apply warm, wet
compresses to promote reabsorption of the
fluid.

What is IV caused Circulatory Overload?

Circulatory overload occurs when the patient’s system is unable to manage the extra fluids administered, leading to cardiac and pulmonary complications similar to congestive heart failure or pulmonary edema. This can be caused by excessive fluid administration or rapid fluid delivery.

What must be monitored during an IV?

Monitor the patient’s vital signs and IV drip rate and watch for any changes.

How do you treat IV caused Circulatory Overload?

Should the patient develop signs of fluid overload,
perform the following interventions:


1. Immediately slow the IV rate to keep the vein
open (abbreviated to TKVO).
2. Place the patient in a semi-sitting position and
apply oxygen if indicated.
3. Transport the patient as quickly as possible and
notify the hospital of your arrival.
4. Closely monitor the patient’s vital signs while en route, and make sure you keep the patient warm to promote peripheral circulation.
5. Document your findings and actions, including slowing the IV rate. Someone with circulatory overload should be treated as a patient with congestive heart failure.

What is Thrombosis?

Thrombosis is the formation of a clot, and usually occurs aat the tip of a catheter.

What is Thrombophlebitis?

Thrombophlebitis is inflammation of a vein due to the formation of a blood clot (thrombus means blood clot and phlebitis means inflammation of a vein).

What may cause a clot to form on an IV?

* The IV is running too slowly.
* There is injury to the vein wall, either from the insertion or from mechanical irritation (e.g., excessive movement of the patient).
* The catheter is too large for the lumen (hollow) of the vein.
* The vein is too small to handle the amount or type of solution being administered.
* There is irritation to the vein by medications (e.g., drug infusions).

How to you treat IV caused Thrombophlebitis?

If thrombophlebitis develops, perform the
following steps:


1. Discontinue the IV.
2. Record the time at which the IV was
discontinued and the amount of fluid infused.
3. Apply warm, wet compresses to decrease
the pain and promote healing. Refrain from
massaging or rubbing the affected arm, as this
may dislodge the clot that has formed.

What is a Catheter Embolism?

A catheter embolism occurs when the catheter or a portion of it breaks off and is carried away in the bloodstream. This rare complication occurs when the IV is initiated.

How do you treat a Catheter Embolism?

If a catheter embolism occurs, perform the
following interventions:


1. Discontinue the IV but do not discard the
catheter. Give the catheter to hospital
personnel for examination and follow-up.
2. Record the time at which the IV was
discontinued and the amount of fluid infused.
3. Be careful not to obstruct the arterial flow;
check the distal pulse to ensure its presence.
4. Administer high-flow oxygen to the patient if
indicated.
5. Notify the hospital and ensure that the patient
is in the rapid transport category.

What are the signs of IV Site Infection?

Infection is usually recognized by redness in the area around the catheter, swelling of the site, or possible discharge.

How do you treat IV Site Infection?

When infection of a site occurs while you are en
route with a patient, perform the following steps:


1. Contact the hospital and request direction.
2. Discontinue the IV and record the time.
3. Document the amount of solution infused.
4. Dispose of the catheter in a sterile container
and give it to hospital personnel for testing.
5. Dress the site with a sterile dressing and apply
a warm pack.

How do you treat an IV Allergic Reaction?

If the patient has an allergic reaction, perform the
following interventions:


1. Decrease the IV rate to keep the vein open or
discontinue the IV (see note).
2. Record the time the IV rate was changed.
3. Notify the hospital.
4. Administer oxygen if indicated.
5. Search for other substances that may have caused the reaction. If unable to find another cause for the reaction, discontinue the IV.