Pharmacology

• Dose
  • The amount of medication that is given
  • Depends on patient's weight or age
  • Depends on the desired action of the medication

• Action
  • The therapeutic effect that a medication is expected to have on the body

• Indications
  • The reasons or conditions for which a particular medication is given

• Contraindications
  • Times when you should not give a patient medication
  • Medication would have no positive effect
  • Medication would harm the patient

• Side Effects
  • Actions of a medication other than the desired ones

2 Types of Medication Names

• Generic
  • its original name or the name which it's given by the manufacturer
  • Not Capitalized
• Trade Name
  • The brand name given by the manufacturer
  • Begins with a Capital Letter

2 Types of Medications

• Prescription
  • Distributed by a pharmacist
• Over-the-Counter (OTC)
  • Purchased directly

Routes of Administration

Absorption

• The process by which medications travel through body tissue until it reaches the bloodstream
• Rate of absorption is often dependent on its route of administration

Routes of Administration

• Intravenous Injection (IV)
• Oral (per os or PO)
• Sublingual (SL)
• Intramuscular Injection (IM)
• Intraosseous (IO)
• Subcutaneous Injection (SC)
• Transcutaneous 
• Inhalation
• Per Rectum (PR)

Intravenous Immediate

Intraosseous Immediate

Inhalation Rapid

Rectal Rapid

Sublingual Rapid

Intramuscular Moderate

Subcutaneous Slow

Ingestion Slow

Transcutaneous Slow

Routes of Administration

Intravenous Injection (IV)

• Into the vein
• Enters the bloodstream immediately
• Fastest way to dekiver a chemical substance
• Cannot be used for all chemicals

Routes of Administration

Oral

• Taken by mouth
• Enters the bloodstream via the digestive system
• Takes up to 1 hr.

Routes of Administration

Sublingual (SL)

• Under the tongue
• Enter through the oral mucosa under the tongue and are absorbed into the bloodstream within minutes
• Protects medications from chemicals in the digestive system (such as acids that weaken them)

Routes of Administration

Intramuscular  Injection (IM)

• Into the muscle
• Absorbed quickly because muscles have a lot of blood vessels
• Potential problems:
• May damage muscle tissue
• Uneven and Unreliable absorption - esp. with hypoperfusion

Routes of Administration

Intraosseous (IO)

• Into the Bone
• Reaches the bloodstream through the marrow
• Requires drilling into the outer layer of the bone
• Painful
• Used in unconscious cardiac arrest patients  or extreme shock
• Most commonly used w/ children who have fewer available IV sites

Routes of Administration

Subcutaneous Injection (SI)

• Beneath the skin
• Into the tissue between the skin and the muscle
• Absorbed more slowly (less blood)
• Effects last longer
• Given when medications cannot be given by mouth
• eg. insulin

Routes of Administration

Transcutaneous

• Through the skin
• eg. nicotine patch

Routes of Administration

Inhalation

• Inhaled
• Absorbed into the bloodstream more quickly
• Work in the lungs (some)
• Helps minimize the effects of the medication in other body tissues

Routes of Administration

Per Rectum (PR)

• By the Rectum
• Delivery is frequently used w/ children because:
• Easier administration
• Reliable absorption
• Used for nausea and vomiting
• Used when a patient cannot swallow or is unconscious

Medication Forms

• If the capsule contains liquid - shell is usually sealed and soft
• If the capsule contains powder - shell can usually be pulled apart
• Tablets are compressed under high pressure
• Tablets often contain materials that are mixed with medication

• Some tablets are designed to dissolve quickly in small amounts of liquid (given sublingually)

Solutions

• Liquid mixture of 1 or more substances that cannot be separated by filtering or allowing the mixture to stand
• Can be given by almost any route
• When given by mouth:
• Solutions may be absorbed fairly quickly
• May be given as IV,IM, or SC

• Do not dissolve well in liquids
• Some can be ground into fine particles and evenly distributed throughout a liquid by shaking or stirring
• eg. activated charcoal
• Can separate if they stand or are filtered
• Important:
  • Shake or stir suspension before administering to ensure patient receives the right amount of medication
• Usually administered by mouth
• Occasionally applied directly to the skin

• Delivers the same amount of medication each time
• Usually suspended in a propellant
• Must be shaken
• Used for respiratory illnesses

• Applied to the surface of the skin
• Applied only in the affected area

• Designed to be absorbed through the skin, or transcutaneously
• eg. nicotine patch, pain medications, contraceptives, nitroglycerin paste - dilate blood vessels in the skin = speec of bloodstream absorption
• Usually intended for systemic effects

• Semiliquid substance
• Orally in capsule form or through plastic tubes
• Consistency of pastes or cream, but clear

• Most commonly used in the operating room
• Concentrated form
• Potent medication that has a systematic effect

Medications Carried on EMS Units

Oxygen

• Given via nonrebreathing mask at 10 - 15L/min (or nasal cannula at 2 - 6L/min = up to 44% insoired oxygen if the flowmeter is set to 6L/min)
• If the patient is not breathing:
  • Provide artificial ventilations (BVM) 15L/min
• Outside the hospital this is the preferred method as it provides up to 90% inspired oxygen

• Poisoning Emergencies taken by mouth- OD
• Many medications bind with activated charcoal - keeps the body from absorbing medications
• Adsorption - to bind to or stick to the surface
• Ground into a fine powder - greatest possible surface area for binding
• Bond between medication and charcoal - not permanent
• Charcoal frequently suspended w/ sorbitol (a complex sugar)
• Laxative effect
• Given by mouth

• Used for hypoglycemia - low blood sugar- to counteract the effects
• Glucose - simple sugar - readily absorbed into the bloodstream
• EMT-B given only via mouth
• Paramedics and hospital staff via IV
• Never administer to an unconscious patient who is unable to protect the airway

• Antipyretic (reduces fever)
• Analgesic (reduces pain)
• antiinflammatory (reduces swelling)
• Inhibits platelet aggregation (clumping)
• Use during a potential heart attack
• Contraindications:
  • Hypersensitivity to aspirin
  • Preexisting Liver damage
  • Bleeding disorders
  • Asthma
  • Reye's Syndrome

• The main hormone used to control the body's 'fight-or-flight' response
• Sudden stress
• different effects on different body tissues
• Generally
• Increase the heart rate and BP and dilate passages to the lung

Medications Carried on EMS Units

Epinephrin Characteristics

• Secreted naturally by the adrenal glands
• Dilates passages in the lungs
• Constricts blood vessels, causing increased BP
• Increases heart rate and BP

Medications Carried on EMS Units

Epinephrin Administration by Injection

• Treatment of anaphylaxis
• SC & IM injections:
• SC - helpful to pinch the skin lightly to lift it away from the muscle 
• SC syringe - short, thin needle, typically 1/2" - 5/8"
• IM syringe - longer 1" - 1 1/2" so it can reach muscle

Patient-Assisted Medications

• Epinephrine
• MDI
• Nitroglycerin
• Contrindications for nitro:
  • Systolic BP less than 100 mm KG Nitro may have harmful effects as it lowers the BP
  • Used with Viagra (w/in the past 24 hrs.) - can be fatal

• Relaxes the muscular walls of coronary arteries and veins
• Results in blood returning to the heart
• Decreases BP
• Relaxes veins throughout the body
• Often causes a mild headache after administration

General Steps in Administering Medication

• Step 1  Obtain an Order from Medical Control (off-line, on-line)
• Step 2  Verify the Proper Medication and Prescription
• Step 3  Verify the Form, Dose, and Route of Medication
• Step 4  Check the Expiration Date and Condition of the Medication
• Step 5  Reassess the Vital Signs
• Step 6)  Document

Polypharmacy

Common Prescribed Medications

High Blood Pressure

To Lower BP by reducing blood volume, affecting the heart, or dilating blood vessels

• atenolol
• furosemide
• hydrochlorothiazide
• triamterene/hydrochlorothiazide (HCTZ)
• quinapril (Accupril)
• ramipril (Altace)
• valsarten (Diovan)
• amlodipine/beazpril (Lotrel)
• losartan (Cozaar)
• valsartan/HCTZ (Diovan HCT)
• benazepril (Lotensin)
• clonidine 
• losartan/HCTZ (Hyzaar)

• atorvastatin (Lipitor)
• amlodipine (Norvasc)
• lisinopril
• metoprolol (Lopressor & Toprol XL)
• simvastatin (Zocor)
• pravastatin (Pravachol)
• clopidogrel (Plavix)
• potassium chloride
• warfarin (Coumadin)
• verapamil
• digoxin
• diltiazem
• fenofibrate (Trocor)

• albuterol
• cetirizine (Zyrtec)
• fexofenadine (Allegra)
• montelukast (Singulair)
• salmetrol/fluticasone (Advair Diskus)
• fluticasone (Flonase)
• mometasone (Nasonex)
• fexofenadine/pseudoephedrine (Allegra D)
• fluticasone propionate (Flovent)
• ipratrpium/albuterol (Combivent)

• hydrocodone/acetaminophen (APAP)
• propoxphene (N/APAP)
• ibuprofen
• celecoxib (Celebrex)
• acetaminophen/codine
• valdecoxib (Bextra)
• naproxen
• oxycodone (APAP)
• oxycodone
• rofecoxib (Vioxx)

• alprazolam
• sertraline (Zoloft)
• zolpidem (Ambien)
• fluoxetine
• venlafaxine (Effexor & Effexor SR)
• lorazapam
• citalopram (Celexa)
• bupropion (Wellbutrin (SR and XL)
• paroxetime (Paxil)
• amitriptyline
• escitalopram (Lexapro)
• trazodone
• risperidone (Risperdal)
• olanzapine (Zyprexa)
• methylphenidate XR (Concerta)

• levothyroxine
• conjugated estrogens (Premarin)
• norgestimate/ethinyl estradiol (Ortho Tri-Cyclen)
• glipizide (Glucotrol & Glucotrol XL)
• norelgestromin/ethinyl estradriol (Ortho Evra)
• rosiglitazone (Avandia)
• pioglitazone (Actos)
• glyburide 
• metformin (Glucophhge & XR)
• glimepiride (Amaryl)
• glyburide/metformin (Glucovance)

• azithromycine (Zithromax)
• amoxicillin
• cephalexin
• amoxicillin/clavulanate
• levofloxacin (Levaquin)
• fluconazole
• penicillin VK
• ciprofloxacin (Cipro)
• sulfamethoxazole/thrimethoprim

• lansoprazole (Prevacid)
• esomeprazole (Nexium)
• pantoprazole (Protonix)
• ranitidine
• omeprazole
• rabeprazole (Aciphex)

• Used to prevent osteroprosis in postmenopausal women:
  • alendronate (Fosamax)
  • raloxifene (Evista)
  • risedronate (Actonel)
• Used for asthma, allergic reactions, severe arthritis, cancer, and other conditions:
  • prednisone

• Used to treat seizures or neurologic pain:
• gavapentine (Neurontin)
• clonazepam 
• Aides in Erectile Dysfunction:
• sildenafil (Viagra)
• Used to relax or decrease spasms in muscles:
• cyclobenzaprine (Flexeril)
• Used to help older men with enlarged prostrate glands (start and sustain urine flow):
• tamsulosin (Flomax)
• Used for Glaucoma:
• latanoprost (Xalatan)