8-10 Communications, pharmacology, Documentation

class

can be classfied by body system, mechanism of action (what we use), class of agent, use

therapeutic action

The specific mechanism by which the drug exerts its effect.

what the medication is intended to do. The benefit. The most important aspect to understand.

Indications

evidence based benefit of administering a med to a specific condition.

contraindication

a predictable harmful outcome of administering a medication based upon specific patient condition

absolute- never given in that circumstance (its absolute unless noted otherwise)

relative- some situations requiring clinical judgement, a weighing of the cost versus benefit of giving med (may be precautions in JCCC)

side effects

predictable, non-therapeutic action- may still benefit clinician (Shows its working)

how supplied

medications vary in concentration, always read labels first.

dosage and admin

amount, route, and method (fast or slow)

precaution

actions to be considered and possibly taken to prevent possible complications

what are the pricipals of safe and effective drug admin

• know your drug

• patient- obtain PMH and med history

• know the pathology and how the med treats it

• protocols

• techniques

• storage and security- proper storage based on manufacturer recomendations

The 6 rights

1. Right patients- if more than 1 pt, make sure it is the right one, do they meet indications and no C/I

2. Right medication- correct drug, concentration, and not expired or discolored.

3. Right dose- ensure you are following protocol or standing orders

4. right route- for efficacy and safety

5. right time- includes rate of admin (fast/slow, IVP or infusion) amd proper repeat times when more doses needed.

6. Right documentation- pt presentation, indication, admin, route, dose, time administered, and pt response

paramedics responabilities when administering substances

storage- all federally controlled substances must be kept LOCKED unless on the person of provider.

detailed documentation of admin must occur, including verbal orders

wasting leftover- must be witnessed and signed off (preferably neutral party)

Log- the DEA requires detailed log of use, restock, and inventory checks on monthly basis.

DEA controlled substances info

I-V

I- soley used for research- most “risky”

II-V may be used for medicinal use

meds that stimulate and inhibit SNS and PNS

stim SNS- sympathomimetic, SNS agonist, adrenergic

Inhib SNS- sympatholytic, SNS antagonist, adrenergic blocker

Stim PNS- parasympathomimetic, PNS agonist, cholinergic

Inhib PNS- parasympatholytic, PNS agonist, cholinergic blocker

types of effects of meds

local- exerts therapeutic actions on specific tissues (like albuterol)

systemic- effects entire body (NTG)

systemic

2 main general medication routes

enteral- passes through GI tract

parenteral- does not pass through GI tract, avoids first pass effect, preffered for rapid absorbtion in EMS

What is the first pass effect in enteral route

when a drug is absorbed by the GI tract and travels through the portal vein to the liver, so some med is absorbed before blood stream

pharmacokinetics

the process by which drug is absorbed, distributed, metabolized, and eliminated. What body does to drug

absorption- route of entry to blood stream. Ph, absorbing surface/blood flow, and drug form/concentration can effect

distribution- travels to tissues or target organs via body fluids. Blood flow, plasma binding, cell membrane, pre-existing disease can effect.

• bioavailability- the speed with which and the amount of drug left to exert its action. Combo of absorption and distribution

metabolism (biotransformation)- the chemical modification of a drug by the body to convert drug into metabolites for excretion

• liver is primary sight for med metabolism

• kidneys, intestines, lungs, plasma, and placenta are other sites

excretion- the removal of metabolites from blood stream.

• kidneys- most common site

• other sites- liver excretes into bile, bile to small intestine into poo, lungs excrete gaseous wastes (anesthetics and alcohol), skin (sweat), breastmilk

pharmacodynamics

the chemical interaction that happens in body after med hits target tissue. What drug does on body.

drug receptor interaction

meds work with certain cells that have unique receptors on membranes. If it works with that cell, it binds and the drug exerts its action.

bioavailability

the speed with which and the amount of drug left to exert its therapeutic action

the amount of non-plasma bound (unbound) drug availble to do its effect. The plasma particles pull some drug onto themselves making the drug unavailble.

how can we modify bioavailability

give sodium bicarb to increase PH making the affinity go up and more drug binds to plasma

affinity

strength of attraction between drug and receptor. If not compatable, no response will occur

efficacy

the ability of a drug to produce a reaction after attaching to receptor, potency of therapeutic effect

agonist and antagonist

agonist- causes physiologic response, has both affinity and efficacy

antagonist- a drug that binds to a receptor and blocks or causes opposite response

competition

multiple drugs or agonist/antagonists competing for a receptor site

plasma-level profile and the different ranges

a description of a drugs activity based on its dosage. Basically the route it takes

sub-therapeutic range- not enough for action

therapeutic range- (window/index)- the ideal blood serum level to ensure a therapeutic effect. Some have a wider window making them safe. Others are narrow making under or overdose likely.

toxic range- above therapeutic range in which 50% of population exhibits signs of OD

lethal range- 50% of pop experience death

half life

the time neccesary for concentration of medication in blood to be reduced by 50 %

• used to determine additional doses and times

• it is logarythmic each set of time (100, 50, 25, 12.5, 6.25)

how do extremes of age effect drug response

pediatrics are smaller

geriatrics have bad metabolism and cant excrete it as well (liver and kidney disease) so sometimes need less since it does not break down as fast. This problem can also be the reason for a 911 call secondary to prescription med.

factors that determine drug response

extremes of age

general health -obese or anorexic

hepatic and renal function

dosage and admin

routes fastest to slowest

IV/IO 1-3 min

Inhaled and IN

IM

SL buccal

SQ

rectal

PO - 15-20 min

therapeutic action

desired, predictable outcome of med admin

drug interaction

the manner in which one drug and another act on each other- not always bad

synergism/summation- the effect of the 2 drugs is greater when together 1+1=3

potentiation- a prolongation or increase in the effect of a drug by another drug,

side effect

an untoward (unintended) effect of drug

idiosyncratic response

an unexpected, adverse response to drug- usally dtermined by genetics. Cant predict

latrogenic response

an unintentional effect or disease created by a medical treatment \

ex. brusies from backboard

tolerance and cross tolerance

tolerance- decreasing responsiveness to the effect of a drug, larger doses required to obtain effect

cross tolerance- tolerence of drug within same class (narcotics), causing tolerence to multiple drugs within class.

advantages, disadvantages of drug delivery routes

PO

SL/buccal

rectal

IV

IO

Inh

IN

IM

SQ

transdermal

intradermal lidocaine wheel

portable radio

mobile radio

base station radio

repeater

antenna

remote counsel

encoder/decoder

mobile phones/data/GPS

portable radio- low power carried on person

mobile radio- medium power located in vehicle

base station radio- high power, usually in building or station

repeater- low power transmission recieved, repeater amplifies signal on same or different frequency. May be at base station or on towers throughout the service area or in a vehicle on scene.

antenna- centrally located, usually up high

remote counsel

encoder/decoder

mobile phones/data/GPS