MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE – BASIC ONLY (EMTB)

December 2013

Pharmacology for the EMT

Medication administration is one of the most important elements of EMT practice. Medication you administer can have many desirable and life saving clinical effects. On the other hand severe and life threatening consequences can occur if you make a mistake. You may often have to make quick decisions about:

• When to administer medication • What medications you need to administer • When administering certain medications would be harmful to the patient

As an EMT you must have a comprehensive understanding of the rules for safe medication administration and follow them at all times. Your patients depend on you.

The 6 “Rights” of Medication Administration

1. The RIGHT patient a. In the field this is the patient lying in front of you b. When doing clinical in the hospital, it is extremely important to check wrist bands for

identifying the right patient 2. The RIGHT drug

a. Check all medications 3 times prior to administration - When you take it out of the drug box or pick up the patients medication bottle - When you prepare it - Just prior to administering it

3. The RIGHT dose a. Double check the dose in the protocol book if you are unsure

4. The RIGHT time a. Is this drug indicated at this time for this patient

5. The RIGHT route a. Is this the correct route of administration for this medication

6. The RIGHT documentation a. Drug name b. Dose – verify order in mg c. Route of delivery d. Time administered e. Person administering the medication f. Patient response to the medication

In addition to the six “Rights”, prior to administering any medication you must also:

• Screen all patients for their allergy status prior to medication administration. If you are in doubt regarding an allergic reaction versus side effect (ie: abdominal distress), contact medical control for clarification

• Check the medication’s expiration date and condition of the medication.

Before You Administer Any Medication You Must Be Knowledgeable About: • The Drug Action/Desired Effect • The Indication For Using The Drug • Dose Range And Drug Calculations • Potential Side Effects • Appropriate Administration Routes • Precautions and Contraindications

Specific Medications Epinephrine (Adrenalin) Action: Catecholamine; sympathetic agonist. At dose in Epi-Pen it relaxes bronchial smooth muscle (bronchodilates); also constricts bronchial arterioles to relieve congestion and edema. It inhibits histamine release and antagonizes effects on end organs. It also:

• Increases automaticity: myocardial electrical activity • Increase heart rate • Increases cardiac output • Increases conduction velocity in the heart

Indication: Moderate allergic reaction or anaphylaxis Dose: Epi-Pens auto injectors have a pre-set dose. Side Effects: Increased heart rate, hypertension, angina, headache, restlessness, dizziness, tremors, lightheadedness, excitability, nausea, vomiting, pallor

Administration route: The epi-pen is given IM in the upper thigh.

Oral Glucose Action: Oral glucose is a carbohydrate that increases serum glucose levels. Indication: Hypoglycemia in awake patients with a GCS of 15, with an intact gag reflex Contraindications: Patients with altered mental status (GCS less than 14) Absent gag reflexes or impaired airway reflexes History of recent Seizure Dose: 25 GM orally Side Effects: Aspiration in patients with impaired airway reflexes Nitroglycerin Action: It is an organic nitrate, vasodilating agent. It dilates coronary vessels, relieves vasospasm and increases collateral blood flow to ischemic myocardium. It is a vascular smooth muscle relaxant that dilates veins

to decrease preload (the amount of blood returning to the heart). It also dilates arterioles to decrease afterload (the pressure the heart has to pump against). Indications: Acute coronary syndrome with suspected ischemic pain EMT may assist patient with administering patient’s own Nitroglycerin Contraindications: BP less than 90/60 or more than 30 mmHg below baseline HR less than 50 or greater than 100 The patient has taken erectile dysfunction drugs: Viagra/Levitra within 24 hours or Cialis within 48 hours Dose: 0.4mg table sublingual Side Effects: Headache, dizziness, syncope, hypotension, flushed skin Albuterol Inhaler Action: It is a selective beta-2 agonist – smooth muscle relaxant causing bronchodilation. Onset of action is 5 – 15 minutes Peak: 30 – 90 minutes Indication: Bronchospasm associated with asthma, COPD, allergic reactions or cystic fibrosis Contraindications: Allergy to medication. Use with precaution in patients with hypertension and increased heart rates Dose: EMT-B may assist the patient with their own meter dose inhaler. Side Effects: Tremors, nervousness, anxiety, dizziness, headache, increased heart rate, palpitations, chest pain, nausea,

Remember • You operate under the license of the Medical Director • You are still individually responsible for having knowledge of the medications you are delivering • Inappropriate delivery of medications, even when the patient does not suffer harm, may result

in legal ramifications • Medical control is always available as an on-line resource - call if you have any questions • Double check order (SOP/Medical Control Orders) • Double Check Drug Label for:

Drug Name (know both generic and trade names Drug Concentration Expiration Date Route of Drug Can be given

• Double Check Drug Integrity Clarity Packaging

EMTs must have a comprehensive understanding of the rules for safe drug administration and the medications they are allowed to administer.

McHenry Western Lake County EMS System OPTIONAL CE – BASIC ONLY (EMTB)

December 2013 Pharmacology for the EMT

Name: _________________________________ Dept: _________________________________ Date: __________________________

1. List the 6 “Rights” of medication administration

2. How many times should a medication be checked prior to administration? _______________

3. In addition to the 6 rights list 2 more things you must do prior to administering the drug.

4. What is the indication for use of an epi-pen.

5. List the contraindications for use of oral glucose.

6. Describe the action of nitroglycerin.

7. List the side effects you may see with someone who used their albuterol inhaler.

8. What needs to be included in your documentation when you give a medication.

9. Explain the action of epinephrine.

10. What is the dose for oral glucose?