Pharm Test 1

Direct Medical Orders

A physician must be contact to proceed (ex/ exceeding a dosage)

Standing Medical Orders

procedures paramedics can perform without consultation (ex/ in NB PCPs can exceed the max dosage of Nitroglycerin)

NOCP

National Occupational Competency Profiles (national standard for paramedics in Canada)

7 rights of Medication Administration

Right patient → Right medication → Right dose → Right route → Right time → Right documentation → Right to refuse

PO

Oral

SL

Sublingual

IM

intramuscular

IV

Intravenous

IN

intranasal

Precaution vs Contraindications

precautions: medication may still be appropriate but consider the risks
Contraindiations: do NOT administer

mL

milliliters

L

liters

g

grams

mg

miligrams

mcg

micrograms

A.M

before noon

P.M

after noon

HS

bedtime

QD

daily

PRN

as needed

STAT

now/immediately

NKA

no known allergy

NPO

nothing by mouth

DC

discontinued

GTTS

drops

oz

ounce

tbsp

tablespoon

tsp

teaspoon

s

seconds

min

minutes

h

hours

d

days

wk

weeks

mo

months

yr

year

<

less than

>

greater than

#

fracture

SC

subcutaneous

PR

per rectum

IO

intraosseous

IH

inhalation

Solution

drug is completely disolved in liquid

Suspension

drug particles are dispersed throughout a liquid, often need to be shaken

Liquid medication advantages

several options for routes of administration, usefull when patients cannot swallow solids, allow flexible dosing, injectibles can have rapid systemic effects

Liquid medication disadvantages

may be less stable, dosing errors can occur if concentration is misunderstood, suspensions may separate, some require special storage

Solid medication advantages

easy to store and transport, good stability/shelf life, accurate standard doses, convenient for many patients

Solid medication disadvantages

usually must be swallowed, absorption slower, can be difficult to administer, some must be crushed or chewed

Gaseous medication advantages

rapid absorption in lungs, large surface area for gas exchange, work quickly, useful when respiratory route is appropriate

Gaseous medication disadvantages

require proper equiptment, administration effected by ventilation and respiratory status, delivery depends on device and patient cooperation

Drug properties

characteristics of a medication that determine how the drug interacts with the body and how it should be stored, prepared, administered, and handled

Solubility

how well a drug dissolves in water or fat, how easily it can cross membranes/distribute into tissues

Stability

shelf-life, how well the drug maintains over time

Ionization & Ph

electrical state of drug, effected by surrounding Ph, influences how easily drug crosses membranes

Concentration

amount of drug present in a specific volume (important to consider with dosing)

Protein Binding

some drugs attach to proteins in the blood

Molecular Size

size and structure of drug molecules can influence how it moves thru membranes and tissues

Buccal medication

placed between the cheek and gum, absorbed through mucous membranes

Oral medications

taken by mouth/swallowed, primarily absorbed in GI tract then enter bloodstream, convenient and non-invasive, absorption can be slower

Sublingual medication

placed under the tongue, absorbed through oral mucosa and enters blood stream, rapid onset of action

Intramuscular medication

injected into skeletal muscle, absorbed from muscle into bloodstream, rate of absorptions depends on muscle, injection side, medication, and formulation

Intravenous medication

administered directly into vein, enters bloodstream directly, rapid and predictable systemic effect

Intranasal medication

sprayed into nose (slide missing information)

Inhalation medication

delivered through despiratory tract, lungs provide large area and extensive blood supply, can be absorbed rapidly, produce local or systemic effects

Subcutaneous (SC/SQ) medication

injected into tissue beneath the skin/above muscle, absorbed thru small blood vessles in subcutaneous tissue, slower administration than IV

Intraosseous medication

delivered directly into bone marrow cavity, provides access to vascular system, used when IV isn’t rapidly accessible

Topical medication

applied directly to skin, usually local effects

Transdermal medication

designed to pass through skin and enter systemic circulation, provide medication over an extended period (usually a patch)

Occular medication

administered to eye, usually local effect, must be appropriately formulated and sterile (eyes very sensitive)

Aural medication

administered into the ear, usually local effects in ear canal or surrounding structures

Slowest absorption to fastest

transdermal → oral → aural → ocular → sublingual → intranasal → inhalation → subcutaneous → intramusvular → intravenous → intraosseous

5 considerations for safe medication storage

temperature, moisture, expiry dates, packaging integrity, stock rotation

High alert medications

medications that can cause serious harm when used incorrectly, require proper attention and consideration when used

Controlled/Restricted medications

medications at a high risk of misuse, must be secured, tracked, documented, and accounted for

7 aspects of safe drug handling

secure storage, controlled access, checking medication integrity, checking expiry dates, maintaing appropriate environmental conditions, following medication-count procedures, reporting discrepancies

Special Patient Population

groups of patients with unique physiological, developmental, or clinical characteristics that affect how medications are tolerated

Pharmacokinetics

what the body does to the drug (absorption, distribution, metabolism, elimination)

Absorption

how the drug gets into the blood

Distribution

where the drug goes in the body (not necessarily distributed evenly throughout the body)

metabolism

how the body changes the drug

Elimination

how the drug leaves the body (urine, feces, exhaled air, sweat, saliva, breast milk)

Pediatrics

under 8yo, doses often weight based, liver and kidneys may not be fully developed, can be more sensitive to certain medications, get accurate weight to calculate dose carefully

Geriatrics

older adults process medications differently, kidney and liver may be less efficient, meds may stay in body longer, may be more sensitive to meds, often on multiple meds

Polypharmacy

patient is taking multiple medications at the same time

pregnancy

treat the mother, consider the fetus, meds are absorbed, distributed, metabolized, and eliminated differently, some meds can cross placenta, necessary emergency meds should NOT be withheld due to pregnancy

Immunocompormised

patient’s immune system is weakened, vulnerable to infection and medication complications