Pharmacology

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Pharmacology

Presented by Mike Helbock, M.I.C.P., SEI Senior
Paramedic, NREMT-P MSO King County Medic
One Manager EMS Training and Education Seattle/K
ing County EMS
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Course Objectives

• The student will learn 3 commonly prescribed
  drugs found in the categories of cardiac,
  respiratory, diabetes, seizures and ulcers.
• The student will identify the medications that
  they can give and those that they may assist
  with.
• Identify medications on the unit.

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Determine

SICK/NOT SICK !
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General Pharmacology

• You will be responsible for administering certain
  drugs.
• You will be responsible for assisting patients
  self-administer other drugs.
• Not understanding how medications work places the
  patient and yourself in danger.

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How Medications Work

• Dose
• Amount of medication given
• Action
• Therapeutic effects expected on the body
• Indications
• Therapeutic uses for a particular drug

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How Medications Work cont.

• Contraindications
• Conditions in which a medications should not be
  given
• Side effects
• Actions of a drug other than the desired effect

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Medication Names

• Trade name
• Brand name given by manufacturer
• Generic name
• Original chemical name

• Prescription drugs
• Prescription drugs.. by MDs order
• Over the counter (OTC) drugs
• Available without a prescription

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Routes of Administration

• Intravenous (IV) injection
• Injected directly into the vein
• Oral (PO)
• Taken by mouth enters body through digestive
  system
• Sublingual
• Placed under the tongue absorbed by mucous
  membranes

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Routes of Administration

• Intramuscular (IM) injection
• Injection into the muscle
• Intraosseous (IO)
• Access to the inside of the bone
• Subcutaneous (SQ) injection
• Injection into tissue between skin and muscle

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Routes of Administration

• Transcutaneous
• Medications absorbed through the skin
• Inhalation
• Medications inhaled into the lungs
• Per rectum (PR)
• Administration by rectum

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Dosage Forms

• Tablets
• Materials mixed with medication and compressed
  under pressure
• Capsules
• Gelatin shells filled with powdered or liquid
  medication
• Solutions
• Liquid mixture of one or more substance

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Dosage Forms

• Suspensions
• Mixture of fine particles distributed throughout
  a liquid by shaking
• Metered-dose inhaler (MDIs)
• Miniature spray canister, used to direct
  medication through the mouth into the lungs
• Topical medications
• Lotions, creams, and ointments

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Dosage Forms

• Transcutaneous medications
• Transdermal
• Designed to be absorbed through the skin
• Gels
• Semi-liquid substances administered orally
• Gases for inhalation
• Oxygen, Nitrous Oxide, Heliox

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Medications Carried on EMS Unit

• Oxygen
• Gaseous medication needed by all cells to
  function.
• Activated charcoal
• Suspension used to absorb ingested poisons
• Oral glucose
• Gel form glucose given orally

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Assisted-Administration Medications

• Epinephrine (Epi-Pen) also carried on unit
• Increases heart rate and blood pressure and
  decreases muscle tone of bronchi... used in
  severe anaphylaxis
• Metered-dose inhaler (MDI)
• Several medications are used to help
• dilate the bronchi...(Asthma, COPD)

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Assisted-Administration Medications cont.

• Nitroglycerin
• Increases blood flow by relieving spasms and
  causing arteries to dilate
• Available in tablet, spray, or paste

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General Steps to Administering Medications

• Obtain orders (Med control or standing)
• Verify proper medication and prescription.
• Verify form, dose, and route of the medication.
• Check expiration date and condition of
  medication

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General Steps for Administering Medicationscont.

• Reassess vital signs after every administration
  of medication.
• Document any medication given and changes in
  patients condition.

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Commonly Prescribed Drugs

• Asthma
• Anxiety / Depression
• Diabetes
• Seizures
• Ulcers
• Pain Control
• Cardiac Related

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Asthma

• Brand Generic
• Proventil Albuterol
• Theodur Theophylline
• Azmacort Triamcinoline
• Atrovent Ipratropium
• Brethine Terbutaline

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Anxiety or Depression

• Brand Generic
• Xanax Alprazolam
• Prozac Fluoxene
• Elavil Amitriptyline
• Tofranil Imipramine

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Diabetes

• Brand Generic
• NPH, Lente Insulin
• Oral preps
• Diabinase Chlorpropamide
• Orinase Tolbutamide
• Micronase Glyburide
• Glucotrol Glipizide

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Seizure

• Brand Generic
• Dilantin Phenytoin
• Tegretol Carbamazepine
• Phenobarbital Phenobarbital
• Depakote Valproic Acid

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Ulcers

• Brand Generic
• Zantac Ranitidine
• Tagamet Cimetidine

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Pain Control

• Brand Generic
• Motrin/ Advil Ibuprofen
• Percocet Oxycodone/aceta..
• Lortab Hydrocodone

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Cardiac...Angina

• Brand Generic
• Nitro-stat Nitroglycerin
• Isordil Isosorbide

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Cardiac...Rapid Heart Rates

• Brand Generic
• Lanoxin Digoxin
• Calan Verapamil
• Cardizem Diltiazem

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Cardiac... High Blood Press.

• Brand Generic
• Procardia Nifedipine
• Capoten Captopril
• Cardizem Diltiazem
• Tenormin Atenolol
• Hydrodiuril Hydrochlorothiazide

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Diuretics (Control CHF)

• Brand Generic
• Lasix Furosemide
• Bumex Bumetanide
• Hydrodiuril Hydrochlorothiazide
• (HCTZ)

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Cardiac..overview

• Brand Generic Condition
• Nitro-stat NTG Angina
• Lanoxin Digoxin CHF
• Procardia Nifedipine Angina, BPs
• Vasotec Enalapril CHF, BP
• Cardizem Diltiazem Angina,BP

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Cardiac (continued)

• Brand Generic Condition
• Calan Verapamil Rhythms
• Inderal Propranolol Angina, BP
• Dyazide HCTZ CHF, BP
• Lopressor Metoprolol Angina,BP

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Cardiac (continued)

• Brand Generic Condition
• Lasix Furosemide CHF, BP
• Micro K Potassium CHF, BP
• Quinidex Quinidine Rhythms
• Coumadin Warfarin Clotting

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How Drugs Work
Drug

Receptor

Cell wall

Drug Interaction with Receptor on the Cell Wall
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Illegal Drug Overdoses

• Methamphetamine
• Cocaine
• LSD, PCP
• Heroin- 1 (Black Tar) in King County
• Methadone (used illegally)

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Prescription Drug Overdose

• Codeine
• Darvocet
• Demerol
• Percodan
• Valium
• Sleeping Pills
• Halcion
• Restoril

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Prescription Drug Overdose... Tricyclics

• Brand / Generic
• Pamelor/Asendin
• Sinequan/Doxepin
• Elavil/Amitriptyline
• Tofranil/Imipramine
• Norpramin/Desipramine

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Over the Counter OTC Drug Overdose

• Aspirin
• Tylenol
• Diet Pills
• Sominex
• Nyquil

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Prescription Labels

• Read the name of the drug, strength and dose (
  spell correctly)
• Look at expiration date
• Confirm that the patient is taking the medication
  as directed
• Confirm when last taken? How much? With any other
  medication?

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Always remember to bringor send ALL pill bottles
and associated medications to the hospital!
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Drugs EMTs can administer

• O2
• Ipecac
• Oral Glucose
• Epinephrine(Epi-pen)

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Drugs EMT can assist with

• NTG
• Epinephrine(Epi-pen)
• Inhalers

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Determine

SICK/NOT SICK !
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• Photos from Emergency Care of the Sick and
  Injured 7th Ed JB Publishers 1998
• Emergency Care of the Sick and Injured 7th Ed
  1998
• King County EMS CBT 1999