Chapter 14 (Medication)

Medication

•  drug or other substance that is used as a remedy for illness

Drug

chemical substance that is used to treat or prevent a disease or condition

Pharmacology

Study of drugs

Polypharmacy

• A person who takes multiple medications daily, prevalent in elderly population 

• All medications must be reported my EMTs duty to ensure that medications to be administered as part of emergency treayment don’t have any negative reactions with existing medication

Acute medications

• Ones that a patient takes for a short period of time to treat most often an acute illness or an exacerbation of chronic illness

Chronic medication

• Maintenance medication used over a long period of time

Medical Direction

• EMTs administer medication under direct order of licensed physician; can administer only the medications identified in the local protocol (within scope of practice)

EMT Medication Administration

• EMT carries out the steps necessary to give the patient the medication via an oral, injection, inhalation, or intranasal route. The patient simply takes direction from the EMT while receiving the medication. 

Patient-assisted medication administration

EMT prepares the medication, and then hands it over to the patient, who will then proceed with taking the medication (usually medications prescribed to patient)

Oxygen

• Odorless, tasteless, colorless gas found in ambient atm at concentration of 21%

• Administered as 100% compressed gas concentration

• Guided by pulse oximeter findings (SpO₂)

Oxygen Indications

• Medical patients: 

  • Adequate breathing and SpO₂ ≥94%, and no other signs of respiratory distress, hypoxia, hypoxemia, or poor perfusion → Do not administer oxygen

  • SpO₂ <94%/signs of respiratory distress, hypoxia, hypoxemia, or poor perfusion → Initiate Oxygen therapy at 2 lpm and titrate to maintain SpO₂ of ≥94%

  • During times of severe hypoxia → nonrebreather mask at 15 lpm, can be replaced with nasal cannula when conditions improves

• Trauma conditions:

  • In patients with traumatic injury (involving brain, thoracic organs, or spinal cord, or one in which there are signs of respiratory distress, hypoxia, hypoxemia, or poor perfusion; or when the potential exists for significant bleeding or shock) 

  • Delivery of Oxygen using nonrebreather at 15 lpm

• Routine oxygen not recommended for someone with adequate oxygen

How does Oxygen administration improve perfusion

• Increasing oxygen concentration breathed in, you attempt to put a higher concentration of oxygen into the alveoli of the lungs

• This increases the amount of oxygen taking part in gas exchange from alveoli into pulmonary capillaries 

• Allows for the availability of more oxygen molecules to attach to hemoglobin and circulate in blood and deliver to hypoxic cells 

Dosage Oxygen

• 2 lpm and titrate to maintain 94% SpO2 of >94% for patients with SpO2 below

• For severe hypoxia/trauma patients provide nonrebreather mask at 15 lpm

Contraindications of Oxygen

• No contraindications

Side effects of Oxygen

• Drying of mucous membranes if not humidified

Oral glucose

• Glucose = Primary energy source for body cells 

• Used for hypoglycemia (especially in diabetic patients) 

• Brain cells can only use glucose for energy while other body cells can use other energy sources during glucose deficit 

Oral glucose dosage

• 15-25 grams of paste

Indications

• Patient with a history of diabetes who is suspected of having a low blood glucose level 

• Absorbed in the mouth and through the intestines and eventually into the blood

Contraindications of oral glucose

• Decreased mental status (unable to manage PO substances)

Side effects of oral glucose

none

Activated charcoal

• Fine black powder that is designed to absorb, or bind, an ingested poison to charcoal 

• Poison is carried by charcoal through digestive tract and eliminated in bowel movement 

• Efficacy = doubtful, removed in many protocols 

• Administered as suspension (mixed into suitable liquid & must be shaken well) 

Contraindications of activated charcoal

• Ipecac administration within 1 hour of charcoal administration 

Dosage of activated charcoal

• 0.5-1 G/kg

Side effects of activated charcoal

• Nausea or vomiting

Aspirin Indications

• Administered to patient who is having chest discomfort or pain that is or may be related to a deficiency in oxygen to the heart 

• Administration of aspirin may keep coronary arteries from closing 

• Not administered for pain relief effects 

• Prevents blood from clotting

Aspirin Dose

• 324 mg (4 tablets 81 mg each)

Aspirin Contraindications

• Bleeding disorders

• Active gastric/peptic ulcer

• Hypersensitivity

Aspirin Side effects

• Gastric irritation

• Exacerbation of gastric ulcers

Inhaled bronchodilator

• Medications that cause the bronchioles to dilate content beta₂ agonists that are topically deposited through an inhalation route on receptor sites in the bronchiole tissue 

• When beta₂ receptor sites are stimulated → causes smooth muscle to relax → dilation of bronchiole → improvement of O₂ delivery due to reduction in airway resistance

Administration/Dose of Metered Dose Inhaler

• Used by a patient who has some sort of respiratory disease (asthma, emphysema, or chronic bronchitis); contains beta₂-agonist drug (beta 2 enhances bronchodilation)

• Patient may also use a non-beta₂ medication (atrovent) → blocks parasympathetic stimulation of bronchoconstriction 

• Dosage = 2 pumps

Small Volume Nebulizar Adm/Dose

• Same as MDI, except for route of administration

• Place medication into a chamber and pass oxygen or compressed air through it to create a fine vapor 

• Fine vapor is expelled through a T-tube and into a mouthpiece or mask and is continuously inhaled for several minutes until medication is completely absorbed

• 2.5 mg diluted in 3 mL/cc of normal saline and administered over 5 to 15 minutes using an oxygen flow rate of 6 to 8 LPM.

Contraindications of Inhaled Bronchodilators

• Poor respiratory tidal volume (amount of air breathing in/out per breath) 

• Tachydysrhythmias 

• Ventricular ectopy (early beat) 

Side effects of Inhaled Bronchodilator

• Tachydysrhythmias

• Ventricular ectopy 

• Anxiety 

• N/V

Nitroglycerin Adm

• Used to treat patients with diseases of the heart that involve partial blockages or spasms of coronary arteries 

• Administered as tablet or spray under the tongue (sublingually) - do not shake or it will alter the dose delivered

• Vasodilator causing a reduction in systemic vascular resistance and improving perfusion; reduces workload of heart by decreasing the force of contraction necessary to eject blood against a lower blood pressure in the aorta and increase supply of blood delivered to heart muscle

NTG Dose

• 0.4 mg (repeated every 5 minutes up to 3 doses)

Contraindications of NTG

• Hypotension

• Hypovolemia (decrease in volume of blood) 

• Increased ICP (intracranial pressure from brain injury, etc) 

• Patient’s use of medication for erectile dysfunction within the past 48 hours

Side effects NTG

• Hypotension

• Syncope (fainting) 

• Headache

• Dizziness

• Flushing

• Tachycardia

Epinephrine Adm

• Treat patients suffering from severe allergic reactions (anaphylaxis) 

• Anaphylaxis causes:

  • Vasodilation → low blood pressure and poor perfusion

  • Bronchoconstriction → difficulty breathing

  • Increased capillary permeability → fluid leaks from blood vessels, causing swelling and decreased blood volume

• Epinephrine reverses these effects:

  • Alpha-1: vasoconstriction → raises blood pressure

  • Beta-2: bronchodilation → opens airways

  • Helps reduce capillary leakage and swelling

  • Beta-1: increases heart rate and strength of contraction

• Epinephrine is commonly given IM (intramuscularly).

• Auvi-Q is another auto-injector and provides voice instructions.

• Some EMS systems use a syringe and vial/ampule instead of an auto-injector.

• Memory tip: Anaphylaxis closes the airways and drops blood pressure; epinephrine opens the airways and raises blood pressure.

Contraindications of Epinephrine

• Myocardial ischemia → vasoconstriction prevents oxygen flow to heart muscle 

• Hypertension → vasoconstrictor, so hypertension increases

• Tachydysrhythmias → Beta-1 can exacerbate this 

• Pulmonary edema → epi backs up pressure in the lungs due to vasoconstriction

Side effects of Epinephrine

• Ventricular ectopy 

• Tachydysrhythmias 

• Angina 

• HT 

• Palpitations

Dosage of Epinephrine

• Adult: 0.3 mg in 1:1,000

• Pediatric: 0.15 mg

Narcan Adm

• Used to treat known or suspected opioid overdose  

• Naloxone is a competitive opioid antagonist that competes for the same receptor binding sites as the opioid drug. When Narcan binds with opioid receptor sites, it effectively blocks the ability of the circulating opioid, such as heroin, to bind with that same receptor site

• Administered intramuscularly, subcutaneously, and intranasally 

• EMTs most often administer Narcan by an intranasal route using a mucosal atomizer device (MAD) attached to a syringe.  

Narcan Dosage

1 mg per nostril; 2 mg in total

Trade Name Oxygen

None

Trade Name Glucose, oral

Glutose, insta-glucose

Trade Name Activated Charcoal

• SuperChar

• InstaChar

• Actidose

• LiquiChar

Trade Name NTG

• Nitrostat (tablet)

Trade Name NTG Spray

Nitrolingual spray

Trade Name Epinephrine

• Adernalin EpiPen, Auvi-Q auto-injectors

Trade Name Albuterol

• Proventil

• Ventolin

• ProAir

• AccuNeb

• VoSpire

Trade Name Levalbuterol

• Xopenex

Trade Name Ipratropim Bromide/Albuterol

• Combivent

• DuoNeb

Trade Name Asp

• Bayer aspirin

• Easprin

• Ecotrin

• Empirin

• Ascriptin

• Bufferin

  • Buffex

Trade Name Naloxone Hydrochloride

• Narcan

• Narcan nasal spray

• EVZIO

Sublingual

• Administered under the tongue

• Dissolved and absorbed across the mucous membrane in the mouth 

• Patient must be alert and responsive

• Medications EMT Administers sublingually = NTG tablet/spray 

Oral (PO)

• Taken by mouth (PO)

• Medication absorbed by small intestine (except for activated charcoal) AKA enteral route 

• Must be responsive and able to swallow 

• • Aspirin • Oral glucose • Activated charcoal

Inhalation (INH)

• • Oxygen • Metered-dose inhaler • Small-volume nebulizer 

Intramuscular injection

• The drug is injected into a muscle mass.

• Absorption is relatively rapid

• Epinephrine by auto-injector (EpiPen, Auvi-Q) or manually by syringe and needle

• Naloxone hydrochloride by auto-injector (EVZIO) or manually by syringe and needle

Intranasal

• The medication is sprayed into one or both nostrils using a specialized delivery device called a mucosal atomizer device (MAD) that is either attached to a syringe or built into the device.

• • Naloxone hydrochloride (Narcan) by syringe and MAD

• • Narcan Nasal Spray (single use device)

Subcutaneous

• injected under the skin into the subcutaneous layer

• slower absorption rate than intramuscular injections

• Naloxone hydrochloride (Narcan) by auto-injector (EVZIO).