Chapter 12: Principles of Pharmacology and Medication Administration

What is an agonist?

A medication that causes stimulation of receptors

What is an antagonist?

Binds to a receptor and blocks other medications or chemicals from attaching

Therapeutic effect?

Desired / intended effect

Pharmacokinetics?

Actions of the body on the medications

Pharmacokinetic properties

Onset of action: Time from medication admin until clinical effects occur

Duration: Length of time that clinical effects persist

Elimination: How medications are removed from the body

Peak: When max clinical effects are achieved

Indications

Reasons/conditions for which a particular med is given

Warning

Nitro may be indicated for chest pain associated with edema

Enteral medications: Enter body through digestive system

Per opposite of mouth (PR): Rapid

Oral (PO): Slow

Sublingual (SL): Under the tongue, rapid

Parenteral medications

Intravenous (IV): Into the vein

• Immediate

Intraosseous (IO): Into the bone

• Immediate

Subcutaneous injection: Under the skin into the fatty tissue

• Slow

Intramuscular injection (IM): Into the muscle (deltoid muscle of the upper arm)

• Moderate

Intranasal (IN): Liquid meds through mucosal atomizer device (MAD)

• Rapid

Transdermal (transcutaneous): Through the skin (patches)

• Slow

Inhalation:

• Rapid

Endotracheal (ET):

• Unpredictable

Antipyretics

Fever reducing medications

What are the rights to administering medication?

Right patient

Right med and indication

Right dose

Right route

Right time

Right documentation

Verbal cross-check for medications

“I am going to give [medication name, dose, and route] for [indication]”

When an EMT is allowed to administer medication

Peer-assisted: Administering medication to yourself or partner

Patient-assisted: Assist patient with admin of their own medication

EMT-administered med: Oxygen, oral glucose, epi, nitro, bronchodilators, naloxone, and aspirin

Aspirin (Bayer)

Action:

• Anti-inflammatory agent and anti-fever

• Prevents platelets from clumping

• Decrease formation of new clumps

Indications:

• Relief of mild pain, headache, muscle aches, fever

• Cardiac chest pain

Contraindications:

• Hypersensitivity

• Recent bleeding

• Suspected stroke prior to CT scanning

• Fevers in kids

Route: PO

Adverse effects:

• Nausea, vomiting, stomach pain, bleeding, allergic reactions

Interaction:

• Caution when patients are taking anti-coagulants

Dose: 160-325 mg in chewable tablets

Administration: Not for trauma induced pain, pt must be able to chew

Albuterol (proventil, ventolin), ipratropium (atrovent)

Action:

• Stimulates sympathetic nervous system

• Causes bronchodilation

• ipra: blocks parasympathetic, smooth muscles relax

Indications:

• Asthma / difficulty breathing with wheezing

Contraindications:

• Hypersensitivity

• Relative tachycardia

• Chest pain of cardiac origin

Route: Inhalation

Adverse effects: Hypertension, tachycardia, anxiety, restlessness

Interaction: Increases effects of other nervous system stimulants

Admin concerns: Patient must inhale all med in one breath must hold breath for 5 seconds after

Epinephrine (EpiPen)

Action:

• Stimulates nervous system

• Causes bronchodilation

Indications: Anaphylaxis

Contraindications:

• Chest pain of cardiac origins

• Hypothermia

• Hypotension

Route: IM

Adverse effects:

• Hypertension

• Tachycardia

• Anxiety, restlessness

Interaction: Increases effects of other nervous system stimulants

Doses:

• Adult: 0.3 mg

• Pediatric <55 pounds 0.15 mg in lateral thigh

Admin concerns:

• Med lasts approx 5 minutes, can repeat dose every 5 to 15 minutes

• Make sure ALS is en route to continue treatment

Naloxone (Narcan, EVZIO auto-injector)

Action: Reverses respiratory depression secondary to opioid overdose

Indications: Opioid poisoning

Contraindications: Hypersensitivity

Route: IM, IN

Adverse effects: Nausea, vomiting

Interactions: Additional doses may be required for severe overdoses

Dose:

• Adult: 2 mg IN or IM auto-injector

• Ped: 0.1 mg/kg, max 2 mg

Admin concerns: Patient may wake up combative

Nitroglycerin (nitrostat, nitromist)

Action: Dilates blood vessels

Indications: Chest pain of cardiac origin

Contraindications:

• Hypotension

• Use of ED meds within 24 hours

• Head injury

Interactions: Increases dilating effects of other blood vessel- dilating meds

Dose: 0.3 to 0.4 mg SL; 0.4 mg spray SL

Admin concerns: Ensure ALS is en route

Oral glucose

Action: When absorbed provides glucose for the cells to use

Indications: Low blood glucose

Contraindications: Decreased level of consciousness, nausea, vomiting

Route: PO

Adverse effects: Nausea, vomiting

Interactions: None

Dose: ½ to 1 tube

Admin concerns: Patient must be awake, have control of the airway, and be able to follow commands

Oxygen

Action: Reverses hypoxia

Contraindications:

• Use in suspected stroke or STEMI

• Unable to obtain SPO2

• Suspected myocardial infarction with SpO2 <90%

• Suspected stroke with SpO2 <94%

Adverse effects

• In patient with normal SpO2, may decrease oxygenation to the heart in myocardial infarction and to the brain in a stroke

General steps for admin medications

1. Obtain an order from medical direction

2. Verify the 4 rights

3. Complete cross check

4. Reassess vital signs at least every 5 min

5. Document your actions and patient’s response

Where is the deltoid injection site located?

About 2 inches below the acromion process (just above armpit level)

Words of wisdom

When documenting a medication, include name of med, dose and route, and vital signs before and after administration

Aspirin and other antipyretics may be administered to a patient orally if:

Authorization from medical control has been obtained

Aspirin is beneficial to patients suspected of having a heart attack because it:

Prevents aggregation of platelets

Nitroglycerin, when given to patients with cardiac-related chest pain:

Relaxes the walls of veins and arteries

Pharmokinetic properties for medications include all of the following except?

The time from admin of med until adverse reactions occur

Separation is especially an issue with medicine such as an

Suspension