Paramedic Inter Facility Transfer TrainingMEDICATION CLASSIFICATIONS

Medication and TransportMost PIFT medications are not found in the National Standard Curriculum for ParamedicMedications usually found being administered to critical care patients

CLASSIFICATIONS OF MEDICATIONS18 classifications of drugs plus OTC medications

CLASSIFICATIONS OF MEDICATIONSAnticoagulantsAnticonvulsantsAntidiabetics Antidysrhythmics Antihypertensives Anti-infectivesAntipsychoticsCardiac glycosides CorticosteroidsDrotrecogin

GI AgentsIV fluidsNarcoticsParenteral NutritionPlatelet Aggregation InhibitorsRespiratory MedicationsSedatives Vasoactive Agents

ALLERGIC REACTIONSAll medications have the potential to create an allergic reactionBe vigilant for signs of allergic reactions or anaphylaxisTreat according to MEMS protocol

OK, lets look at the drug classifications in the PIFT program

ANTICOAGULANTSUsed to prevent extension of existing clot or formation of new blood clotsDoes not dissolve existing clotsPatients may be on these drugs for extended periods of time

ANTICOAGULANTSPATIENTS ON ANTICOAGULANTS

MI or suspected MI patientsDVTdeep vein thrombosispulmonary embolismDICdisseminated intravascular coagulationOther clotting-related disorders

ANTICOAGULANTSMost commonly used anticoagulants:

HeparinLovenox (Enoxaparin)Generally administered IV but in certain cases may be given SQ

ANTICOAGULANTSWhat to watch for:

Signs of bleeding, either internally or externallyMonitor vitals frequentlySigns and symptoms of shockAltered level of consciousness

ANTICOAGULANTSPotential interventions in case of adverse reaction:

Consider discontinuing drugControl any external bleedingTreat for shockConsider contacting medical control

THROMBOLYTICSParamedics are not permitted to transport patients with thrombolytic drugs running BUT..Paramedics may transport patients shortly after completion of thrombolytic therapy.These patients may present in several different ways

THROMBOLYTICSPatients may have received thrombolytics for either an acute MI or non-hemorrhagic CVAPatients have reperfused and have improved ORFailed perfusion and continue to show symptoms

THROMBOLYTICSWhat to watch for during transport:Signs of bleedingParticularly intracranial or GI bleedingSigns of shock Altered level of consciousnessHypotensionDysrhythmias

THROMBOLYTICSPotential interventions for adverse reactions:Treat dysrhythmias as per Maine EMS protocolsGeneral supportive measuresConsider fluids for hypotensionContact OLMC for options including diversion

ANTICONVULSANTSUsed primarily to prevent or treat seizuresSeizures are often associated with epilepsy, head injury, fever, infection or unknown etiology

ANTICONVULSANTSAnticonvulsants consist of three types of drugs:BenzodiazepinesBarbituratesDilantin or Cerebyx

ANTICONVULSANTSBENZODIAZEPINES:Lorazepam (Ativan)Midazolam (Versed)Diazepam (Valium)

ANTICONVULSANTSMay be administered IV, IM, PO or rectally in infants

Usually administered by IV infusion pump during interfacility transport

ANTICONVULSANTSBarbiturate of choice for many years has been PHENOBARBITAL

DILANTIN (phenytoin) and CEREBYX (fosphenytoin) are also frequently used to suppress and/or control seizure activity

ANTICONVULSANTSIt is not uncommon to see 2 or more different anticonvulsants used in combination during interfacility transportDoses may have to be altered during transport due to increased seizure activity

ANTICONVULSANTSWhat to watch for:HypotensionRespiratory depressionVomitingBradycardia and other dysrhythmiasIncreased seizure activity

ANTICONVULSANTSPotential interventions in case of adverse reaction:Consider discontinuing drug or drugsConsider fluids for hypotensionSupport ventilations as necessaryTreat dysrhythmias per Maine EMS protocolsIf increased seizure activity occurs, consider increasing dosage if permitted by transfer order or contact OLMC

ANTIDIABETICSIn the context of interfacility transport, it is not uncommon to encounter patients that require treatment with antidiabetic agentsIn most cases, the medication that you will be monitoring or administering will be INSULIN.

ANTIDIABETICSPatients will generally have a diagnosis of:HyperglycemiaHyperglycemic comaHyperosmolar hyperglycemic nonketotic coma

ANTIDIABETICSINSULIN comes in many forms. They are generally either rapid, intermediate or long acting preparations.Common names include the following:HumulinNovolinNPHIletinLantus

ANTIDIABETICSAdministration will generally be by IV infusion in the interfacility mode butIn some long distance transfers it may be necessary to administer the patients routine dose of insulin by subcutaneous injection

ANTIDIABETICSBlood glucose monitoring may be necessary depending on the patients condition and the length of the transfer

ANTIDIABETICSWhat to watch for during transport:Seizures Alterations in blood glucose Signs and symptoms of hypoglycemiaNausea, anxiety, altered level of consciousness, tachycardia, diaphoresis

ANTIDIABETICSPotential interventions:Treat hypoglycemia or seizures as per Maine EMS protocolsConsider discontinuing or altering the infusion rate of insulin as per OLMCProvide general supportive measures

ANTIDYSRHYTHMICSThis is the largest classification of medication in the PIFT module as it contains several sub-classifications

ANTIDYSRHYTHMICSContained within this section are the following sub-classes of medications:Beta BlockersCalcium Channel BlockersCardiac GlycosidesMiscellaneous Antidysrhythmics such as:Amiodarone (Cordarone)Magnesium sulfateProcainamide (Pronestyl)Phenytoin (Dilantin)Lidocaine

NOTECertain medications will appear in several different classifications during this program as some of them are indicated for different medical conditions.Ex. Beta blockers and calcium channel blockers appear in this section as antidysrhythmic agents but will also be seen in the section on Antihypertensives

ANTIDYSRHYTHMICSWhat kinds of patients will we see on antidysrhythmic medications?CARDIAC PATIENTSConfirmed or suspected MIsAnginaTachydysrhythmiasBradydysrhythmias with or without heart blocksAtrial fibrillation and flutterPVCs and other ectopic conditions

BETA BLOCKERSMetoprolol (Lopressor)Propranolol (Inderal)Atenolol (Tenormin)Esmolol (Brevibloc)

During transport primarily used to treat various tachydysrhythmias, atrial fibrillation and atrial flutterUsed to treat MIs but generally given in hospital prior to transfer

CALCIUM CHANNEL BLOCKERSDiltiazem (Cardizem)Verapamil (Calan)Nifedipine (Procardia)

Treatment of tachydysrhythmias, atrial fibrillation and flutter

CARDIAC GLYCOSIDESDigoxin (Lanoxin)

Treatment of tachydysrhythmias, particularly to control ventricular rate in atrial fibrillation or flutter; PSVT

AMIODARONEGenerally used to treat atrial and ventricular tachydysrhythmias during interfacility transport

LIDOCAINEUsed to treat wide complex tachycardia and ventricular ectopy

ROUTES OF ADMINISTRATIONAntidysrhymics will almost always be administered IV by infusion pump

ANTIDYSRHYTHMICSWHAT TO WATCH FOR DURING TRANSPORT:DysrhythmiasAltered levels of consciousnessHypotension/changes in vital signsSeizures

ANTIDYSRHYTHMICSPotential interventions in case of adverse or allergic reaction:Treat dysrhythmias and seizures per Maine EMS protocolsConsider fluids for hypotension if not contraindicated by patients conditionOLMC for option of discontinuing drug, adjusting dosage or diversionGeneral supportive measures

ANTIDYSRHYTHMICSKEEP IN MIND THAT ALL PATIENTS ON CARDIAC MEDICATIONS SHOULD BE TRANSPORTED ON A CARDIAC MONITORRecord any changes in rhythmTake frequent vitals

ANTIDYSRHYTHMICSREMEMBER THAT CARDIAC PATIENTS CAN DETERIORATE QUICKLY AND YOU MUST BE PREPARED FOR A CODE OR OTHER SERIOUS EVENT AT ALL TIMES

ANTI-INFECTIVESIncludes the following:

AntibioticsAntivirals Antifungal agents

Rarely will we see an antiviral or antifungal agent on an interfacility transfer

ANTI-INFECTIVESWhat types of patients can we expect to see on anti-infectives?Pneumonia/respiratory infectionsMeningitisSepsisCellulitisUTIVarious infectious diseases

ANTI-INFECTIVESMost common medications used in transport:VancomycinRocephinPenicillinCefazolin (Ancef)Gentamicin

ANTI-INFECTIVES

Almost always administered IV

ANTI-INFECTIVESWhat to look for:Signs and symptoms of allergic reactionInduration or redness at the IV siteAltered level of consciousnessNausea/vomiting

ANTI-INFECTIVESNote:Antibiotics have a greater potential for allergic reactions than any other drugs

ANTIHYPERTENSIVESThese medications are essentially used to control hypertensive crisis of various etiologiesIncluded within the classification of antihypertensives are several other classes of medications that have antihypertensive action

ANTIHYPERTENSIVESOther classifications and subclassifications of antihypertensives include:ACE InhibitorsBeta BlockersAlpha BlockersCalcium Channel BlockersDiureticsVasodilators

COMMONLY USED ANTIHYPERTENSIVESCOMMONLY USED ANTIHYPERTENSIVES

ACE InhibitorsBenazepril (Lotensin)Enalapril (Vasotec)Lisinopril (Zestril)Captopril (Capoten)

ANTIHYPERTENSIVESAlpha BlockersDoxazosin (Cardura)Prazosin (Minipress)Terazosin (Hytrin)

ANTIHYPERTENSIVESBeta BlockersAtenolol (Tenormin)Propranolol (Inderal)Metoprolol (Lopressor)Labetalol (Normodyne)

ANTIHYPERTENSIVESCalcium Channel BlockersDiltiazem (Cardizem)Verapamil (Calan)Nifedipine (Procardia)Amlodipine (Norvasc)

ANTIHYPERTENSIVESDiureticsFurosemide (Lasix)Bumetadine (Bumex)Torsemide (Demadex)

ANTIHYPERTENSIVESVasodilatorsHydralazine (Apresoline)Minoxidil (Loniten)Nitroglycerin

ANTIHYPERTENSIVESRoutes of Administration:Generally IV but may be given PO in certain cases on long transfers

ANTIHYPERTENSIVESWhat to watch for during transportSevere hypotensionNausea/vomitingSymptomatic bradycardiaOther dysrhythmias

ANTIHYPERTENSIVESPossible interventions when adverse reactions occur during transport:Treat bradycardia and other dysrhythmias as per Maine EMS protocolsConsider fluids for hypotension if not contraindicated by patient condition

ANTIHYPERTENSIVESPossible Interventions when adverse reactions occur during transport:Consider promethazine ( Phenergan ) for nauseaContact OLMC for options of discontinuing medication, altering dosage or diversion

ANTIHYPERTENSIVESAll patients on antihypertensive medications should be transferred on a cardiac monitorTake frequent vitals

BREAK

SCENARIO 1You are transporting a cardiac patient from a local community hospital to Eastern Maine Medical Center. The patient has a diagnosis of unstable angina. Transport time to EMMC is approximately 90 minutes.As you left the sending facility, the patient had the following vitals:

HR---76BP---122/76 R---18

MedicationsOxygen at 4 lpm via ncNitroglycerine IV 14 mcg/minHeparin IV 1000u/hourAggrastat IV 80mcg/minYou also have orders for Morphine 2-5 mg prn for pain managementSCENARIO 1

SCENARIO 130 minutes into the transfer your patient begins to appear anxious, becomes slightly diaphoretic, and complains of some SOB. You take a new set of vitals:HR---104BP---96/62R-----20

SCENARIO 1What do you suspect?What action would you take?What questions do you have for medical control?

ANTIPSYCHOTICSThe number of psychiatric transfers has increased dramatically in recent yearsA many patients are transferred with chemical restraints and sometimes need to be given additional medication during transport

ANTIPSYCHOTICSMedication is administered to control psychotic behavior that is otherwise difficult to manage in an ambulancePatients will have a number of different diagnoses including agitation, schizophrenia, depression, delusional disorders, etc.

ANTIPSYCHOTICSA number of different medications are used to provide chemical restraint

CHEMICAL RESTRAINTCommon Chemical Restraint Medications:Haloperidol (Haldol)Chlorpromazine (Thorazine)Risperidone (Risperdal)Benzodiazepines (Diazepam, Lorazepam, Midazolam)

CHEMICAL RESTRAINTThese drugs may be given alone or in combination with other antipsychotic drugsMay also be administered in combination with other medications such as diphenhydramine (Benadryl) for added sedative effect

ANTIPSYCHOTICSRoutes of administrationGenerally given IV but may be given IM or PO in some casesFor IV medication, the patient should leave the hospital with a saline lock in place if possible

ANTIPSYCHOTICSConsiderationsDiscuss all medication issues with the sending physician before leaving the hospitalIf the patient is sedated upon your arrival, ask if the drug will last long enough for you to reach your destinationTransfers of more than 2 hours are not uncommon

ANTIPSYCHOTICSConsiderationsIf medication will be needed during transport, do not wait until the patient becomes disruptive and combativeMake sure that any patient who is medicated or may require medication during transport is Blue papered

ANTIPSYCHOTICSWhat to watch for during transport:Respiratory depressionHypotensionSeizuresExtrapyramidal reactionsAgitation, muscle tremor, drooling, tremors, etc.

ANTIPSYCHOTICSPotential interventions in cases of adverse or allergic reactions:Treat allergic reactions and seizures as per Maine EMS protocolsSupport ventilations as necessary and be prepared to intubateConsider fluids for hypotensionDiphenhydramine for extrapyramidal reactionsOLMC for other options including diversion

CARDIAC GLYCOSIDESThese are essentially digitalis preparationsThe most commonly used drug is digoxin (Lanoxin)Generally used to treat atrial fibrillation, atrial flutter or atrial tachycardiasSometimes used to treat CHF

CARDIAC GLYCOSIDESRoute of Administration:Generally IV infusion

CARDIAC GLYCOSIDESWhat to watch for during transport:Dysrhythmias including heart blocksCardiac arrestNausea/vomitingDigitalis toxicity

CARDIAC GLYCOSIDESPotential interventions for adverse reactions:Treat all dysrhythmias per Maine EMS protocolsConsider promethazine for nausea/vomitingContact OLMC for options of discontinuing drug, altering dose or diversion

CARDIAC GLYCOSIDESAll patients on cardiac glycosides must be transported on a cardiac monitor and watched carefully for developing adverse reactions

CORTICOSTEROIDSMedications in this class are primarily used to treat the following:Cerebral edema associated with head injuryStatus asthmaticusTo suppress the immune system in cases of severe allergic reactions/anaphylactic shockChronic inflammatory conditions

CORTICOSTEROIDSRoutes of administration:IV infusion in most casesAlso used in inhaled form for certain respiratory conditions

CORTICOSTEROIDSCommonly used medications in this classBetamethasone (Celestone)Dexamethasone (Decadron)Methylprednisolone (Solu-Medrol)Hydrocortisone (Solu-Cortef)

CORTICOSTEROIDSAlso in inhaled formBeclomethasone (Beconase, Beclovent)Triamcinolone (Azmacort, Kenalog)Flunisolide (Aerobid)

CORTICOSTEROIDSWhat to watch for during transport:HypertensionNausea/vomitingCHF

CORTICOSTEROIDSPotential interventions in case of adverse reactions:Follow Maine EMS protocols for allergic reactions, CHF or nausea/vomitingContact OLMC for options of discontinuing drug

DROTRECOGINAn antisepsis agentUsed to treat severe sepsis or septic shockAdministered by IV infusion only

DROTRECOGINWhat to watch for during transport:Be alert for signs of internal bleedingShock symptoms

DROTRECOGINPotential interventions during transport :Treat for shock Contact OLMC for option of discontinuing drug

GASTROINTESTINAL AGENTSUsed to treat a variety of GI disordersSeveral different sub-classifications of GI medications:Proton Pump InhibitorsSomatostatin AnaloguesH2 BlockersAnti-emetics

Protein Pump InhibitorsCommonly used drugs:Protonix Prevacid

Somatostatin AnaloguesCommonly used drug:Sandostatin

H2 BlockersCommonly used drug:Famotidine (Pepcid)Cometidine (Tagamet)

Anti-emeticsmetoclopramide (Reglan)ondansetron (Zofran)prochlorperazine (Compazine)

GASTROINTESTINAL AGENTSWhat kind of patients will we see being transported on these medications?Active duodenal or gastric ulcersGERDgastric esophageal reflux diseaseUpper GI bleedEsophageal varices

GASTROINTESTINAL AGENTSRoutes of Administration:IV infusionPO

GASTROINTESTINAL AGENTSWhat to watch for during transport:Adverse reactions are rare but may consist of dysrhythmiasHypoglycemia is possible but will probably only be seen on longer transfers

GASTROINTESTINAL AGENTSPotential interventions for adverse or allergic reactions:Treat dysrhythmias and hypoglycemia per Maine EMS protocolsConsider termination of drugOLMC for further options

IV FLUIDSConsists of a wide variety of fluids including the following:Normal saline, NSLactated Ringers D5W and D10WDextran, PlasmanateHetastarch, albumin

IV FLUIDSWhy do we give IV fluids during transport?Increase or maintain blood volume and blood pressureMaintain hydrationAccess for medicationTreat hypoglycemia (D10W)

IV FLUIDSWhat to watch for during transport:Signs of fluid overloadEdemaPulmonary edemaTake vitals often to monitor BP

IV FLUIDSPotential interventions in cases of adverse reactions:Consider discontinuing or reducing rate of infusionTreat CHF per Maine EMS protocols

ELECTROLYTESElectrolytes consist of the following:PotassiumCalciumSodium chlorideSodium bicarbonate (alkalizing agent)

ELECTROLYTESWhat type of patients will we see who require electrolyte therapy?Patients requiring potassium supplementation due to deficiency diseases when oral replacement is not feasibleThose who have lost potassium due to severe vomiting or diarrhea

ELECTROLYTESWhat type of patients will we see who require electrolyte therapy?Patients with severe hypocalcemiaSodium depletionPatients requiring sodium bicarbonate to treat hyperacidity or metabolic acidosis due to shock or dehydration

ELECTROLYTESRoute of administration:Primarily IV infusion

ELECTROLYTESWhat to watch for during transport:DysrhythmiasSeizuresSigns and symptoms of allergic reactions (rare)

ELECTROLYTESPotential interventions in cases of adverse reactions:Treat seizures and dysrhythmias per Maine EMS protocolsConsider option of discontinuing drug or modifying dose as per OLMC or transfer orders

NARCOTICSUsed to control moderate to severe painMay be administered by IV infusion pump but may also be given by IV or IM injection as per transfer order

NARCOTICSCommonly used narcotics:FentanylMorphineHydromorphone (Dilaudid)Meperidine (Demerol)Pentazocine (Talwin)

NARCOTICSWhat to watch for during transport:Respiratory depressionHypotensionNausea/vomitingBradycardia

NARCOTICSPotential interventions in cases of adverse reactions:Consider discontinuing medicationTreat dysrhythmias per Maine EMS protocolsConsider Naloxone Assist ventilations as necessary and be prepared to intubate

PARENTERAL NUTRITIONUsed to treat the following:Patients requiring nutrition who are unable to take food and/or fluids by mouthPatients requiring vitamin supplements to prevent or treat vitamin deficiency conditions

Common forms include the following:Vitamin solutionsTPN (Total Parenteral Nutrition)An individualized solution designed to meet the needs of the patient

PARENTERAL NUTRITION

PARENTERAL NUTRITIONWhat to watch for during transport:Adverse or allergic reactions are rare but have been seenHypoglycemia Can occur since most TPN preparations contain Insulin

PARENTERAL NUTRITIONPotential interventions in case of adverse reactions:Treat hypoglycemia as per Maine EMS protocolsConsider discontinuing drug

GLYCOPROTEINIIb/IIa Platelet InhibitorsWhat are these drugs all about? They are potent agents that inhibit platelets from aggregating or clumping together in the context of coronary artery disease. Frequently used in combination with Heparin

GLYCOPROTEINIIb/IIa Platelet InhibitorsPatients being transported on these drugs Acute MIUnstable anginaAcute coronary syndromeMany of these patients are being transported to the cath lab for diagnostic and/or interventional catherization---angioplasty

GLYCOPROTEINIIb/IIa Platelet InhibitorsRoute of Administration:IV infusion only

GLYCOPROTEINIIb/IIa Platelet InhibitorsWhat to watch for during transport:Any signs of bleedingSigns and symptoms of shockChanges in level of consciousness

GLYCOPROTEINIIb/IIa Platelet InhibitorsPotential interventions in cases of adverse or allergic reactions:Control any external bleedingTreat for shock as neededContact OLMC for options of discontinuing drug, altering dose or diversionIn cases of suspected bleeding, the provider may also have to D/C heparin if it is also being administeredTreat dysrhythmias and allergic reactions as per Maine EMS protocols

MULTIPLE MEDICATIONSKeep in mind that you will often be transporting patients on 2, 3 or even more medicationsEg.: It is common to transport a cardiac patient on nitroglycerin, Heparin and Aggrastat with an order to administer Fentanyl for pain as needed.

SCENARIO 2We have discussed the option of diversion to a nearby hospital in almost each of the classifications that we have examinedThis is often a difficult decision to make for a number of reasonsWhat are the potential benefits of diversion?

SCENARIO 2What are the potential negative aspects of diversion?What factors should be considered in deciding to divert?Can you divert without authorization from OLMC?

SCENARIO 2DIVERSION CONSIDERATIONSPatient conditionTransfer ordersAbility to treat Distance to receiving or sending facilityConsult with OLMCComfort level of paramedic

RESPIRATORY MEDICATIONSWithin this classification are several subclassifications of drugs that are used in treating patients with respiratory conditionsBeta agonistsAnticholinergicsSteroids MucolyticsMiscellaneous

BETA AGONISTSAlbuterol (Proventil) TerbutalineMetaproterenol (Alupent)Piruterol (Maxair)

These drugs provide relief through bronchodilation

ANTICHOLINERGICSIpratropium (Atrovent) These drugs provide long term maintenance of bronchodilation

STEROIDSBeclomethasone (Beclovent)Flunisolide (AeroBid)Fluticasone (Flovent)Triamcinolone (Azmacort)

These drugs provide relief by reducing inflammation

MISCELLANEOUSAminophyllineMontelukast (Singulair)

RESPIRATORY MEDICATIONSWhat kinds of patients will you be transporting on respiratory medications?The respiratory problem may be primary or secondaryAcute or chronic

RESPIRATORY MEDICATIONSAsthmaCOPDEmphysemaCertain cases of allergic reaction

RESPIRATORY MEDICATIONSRoutes of administration:Most of these drugs will be administered by inhaler or nebulizedAminophylline is given by IV infusionTerbutaline may be IV or by inhalationIs epinephrine a respiratory medication?

RESPIRATORY MEDICATIONSTransport respiratory medication patients on cardiac monitor

RESPIRATORY MEDICATIONSWhat to watch for during transport:DysrhythmiasBeta agonists such as Albuterol can cause tachydysrhythmiasPalpitations, chest pain

RESPIRATORY MEDICATIONSPotential interventions in case of adverse reaction:Treat dysrhythmias and chest pain per Maine EMS protocols

SEDATIVESSedatives consist of a variety of medications from several different classifications (Some that we have already reviewed)NarcoticsBenzodiazepinesAntipsychoticsBarbiturates and anesthetics

SEDATIVESNarcoticsFentanyl, morphine, dilaudid, meperidine, etc.Benzodiazepines Diazepam, lorazepam, midazolamAntipsychoticsHaloperidol, risperidone, chlorpromazine, etc.BarbituratesPhenobarbital, thiopental, amobarbitalAnestheticsEtomidate, propofol

SEDATIVESNOTE: Paramedics will not transport patients on anesthetics unless accompanied by an RNMost patients on anesthetics are intubated

SEDATIVESTypes of patients on sedativesAgitation and combativeness associated with head injury, psychosis, etc.Control of seizure activityAny condition where it is necessary to provide sedation

SEDATIVESWhat to watch for during transport:Respiratory depressionHypotensionBradycardia

SEDATIVESPotential interventions in cases of adverse reactions:Oxygen, Support ventilations as necessary and be prepared to intubateTreat bradycardia per Maine EMS protocolsConsider fluids for hypotensionOLMC for other options

SEDATIVESTake vitals oftenTransport on cardiac monitor

VASOACTIVE AGENTSThese are medications that have an effect on the tone and caliber or diameter of blood vesselsVasopressors and sympathomimetic drugs cause constriction of blood vessels.Nitrates, vasodilators, Calcium Channel Blockers and ACE Inhibitors cause relaxation and dilation of vessels, thereby reducing BP

VASOACTIVE AGENTSWhat kinds of patients will we see on Vasopressors and Sympathomimetics?Patients on these drugs are generally being treated for hypotension and certain types of shock

VASOACTIVE AGENTSCommonly used vasopressors and sympathomimetics:Vasopressin (Pitressin)Metaraminol (Aramine)Dopamine (Intropin)Dobutamine (Dobutrex)Epinephrine and norepinephrineIsoproterenol (Isuprel)

NITRATESPatients taking nitrates are generally being treated for ischemic chest pain or hypertensive crisis

NITRATESCommonly used nitrates include:NitroglycerinNitroprusside (Nipride)

VASODILATORSUsed primarily for treatment of hypertensive crisis and management of CHF

Calcium Channel Blockers and ACE Inhibitors are primarily used to treat hypertension as we saw in the section on AntihypertensivesVASOACTIVE AGENTS

VASOACTIVE AGENTSRoutes of administration:IV infusionUsually by infusion pump

VASOACTIVE AGENTSWhat to watch for during transport:Severe hypotension or hypertensionDysrhythmiasDyspneaAltered level of consciousnessNausea/vomiting

VASOACTIVE AGENTSPotential interventions in case of adverse or allergic reactions:Treat dysrhythmias as per Maine EMS protocolsConsider fluids for hypotensionConsider discontinuing drug or modifying dose as per OLMC or transfer orderDiversion

VASOACTIVE AGENTSNOTE:These patients must be transported on a cardiac monitorMonitor vitals frequently

OTC MEDICATIONSDuring the course of a transport, particularly a long distance transfer, it may be necessary to administer certain commonly used OTC medications

OTC MEDICATIONSMay include medications for the following:Pain (Ibuprofen, acetaminophen, etc.)Motion sickness (Dramamine)Antacids Antihistamines

OTC MEDICATIONSGuidelines for administration:Written order by physician that includes name of drug, route of administration, indication, dose and time of initial and repeat dosingDrug must be supplied by the sending facilityDrug must have been used previously by patient without adverse reactions

OTC MEDICATIONSAdministration must be documented as with all other medicationsRemember that even OTC drugs can result in adverse or allergic reactions so watch for any such reactions following administration

PRESCRIPTION DRUGSDuring longer transports you may need to administer one or more of the patients regular prescription drugsThe drug must be included in one of the classifications that are part of the PIFT module

CONCLUSIONSBe constantly alertpatients can change in secondsKnow your drugs---use resourcesRemember that every drug, even OTC drugs, have the potential to result in a serious adverse reaction

CONCLUSIONSNever leave the sending facility unless you feel thoroughly comfortable with your patient and with the medications you are being asked to administer or monitor

CONCLUSIONSMake sure that you are thoroughly prepared for any complicationKnow where possible diversion hospitals are locatedUse OLMC whenever necessary

Questions?