EMR-Outcome 6-fillable PDF

Preview

Summary

fillable notes...

Description

EMR LECTURE NOTES

Outcome 6: Pharmacology

11762 - 106 Street NW Edmonton, Alberta, Canada T5G 2R1 www.nait.ca a leading polytechnic committed to student success

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

PERSONAL WELL-BEING

•

What is Pharmacology? »

The study of medications and their interactions is called pharmacology.

Drug Names •

During development, a drug can have up to 4 names: »

Chemical •

»

Official •

»

Found in the Compendium of Pharmaceuticals

Generic •

»

The chemical/molecular structure of the drug

Short form of the chemical name

Trade •

Brand name given by the manufacturer

Sources •

Plants »

•

Morphine (Opium)

Animals & humans »

Epinephrine/Insulin

PAGE 2

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

Minerals »

•

Microorganisms »

•

Sodium/Potassium

Penicillin

Synthetic (man-made) »

Epinephrine/Insulin

Forms of Medication •

Solid »

•

Liquid »

•

•

Elixir, suspension, syrup

Gas »

•

Tablet, capsule

Oxygen, nitrous oxide

Medication Preparations: »

Usually dictates the route of medication delivery

»

The form or route ensures the timing of the medication release into the bloodstream and its effect on its target organs or body system

Class: »

Drugs are grouped into classes by the way they are used to treat particular health conditions, have similar chemical structure, and/or have common effects and actions on the body •

Example: Bronchodilators PAGE 3

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

Absorption: The movement of a drug from its site of administration into the bloodstream

•

Factors that Affect Absorption: »

Nature of the absorbing surface •

»

Blood flow to the site of administration •

•

The greater the surface area, the greater the absorption

The higher the area of blood flow, the greater the speed of absorption

Solubility »

The more soluble the medication, the easier it will pass across the surface

•

pH

•

» Of both the drug and the body environment Concentration »

•

Dosage form »

•

Solid, liquid, gas

Bioavailability »

•

Loading dose for immediate effect vs. maintenance dose for continuous effect

How much of the drug reaches the central circulation; e.g. IV is 100%

Routes of Medication Administration: »

enteral - via the GI tract – slow

»

e.g. PO PAGE 4

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

»

parental – outside the GI tract – fast

»

e.g. IV

Mechanisms Involved in Absorption: »

Diffusion •

»

Osmosis •

»

•

•

Constant movement of molecules from an area of high concentration to an area of lower concentration

Allows water to proceed from one side of a membrane to another

Distribution: The movement of drugs throughout the body

Determined by 3 Major Factors: »

Blood flow to tissues

»

The ability of a drug to exit the vascular system

»

The ability of a drug to enter cells

Blood Flow to Tissues »

Most areas are well perfused

»

The rate at which drugs are delivered to a particular tissue is determined by blood flow to that tissue

»

Limited blood flow may affect drug therapy; e.g., abscess, tumor, clots

PAGE 5

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

•

Exiting the Vascular System »

The ability to leave the vascular system is an important determinant of drug actions

»

Necessary for metabolism and excretion

»

Drugs leave via the capillary bed, to which most offer no resistance

However… »

The body has protective mechanisms such as the Blood Brain Barrier (BBB)

»

The BBB is highly selective; drugs must be lipid soluble or have a transport system in order to leave the blood and reach their sites of action within the brain

Metabolism »

Also known as Biotransformation •

Metabolism refers to the chemical modification (or modifications) made by an organism on a chemical

•

Most drug metabolism occurs in the liver (hepatic)

•

Special Considerations: »

Age: •

•

the liver isn’t fully developed until one year old, and is therefore sensitive and may potentiate injury

Excretion »

The removal of drugs from the body PAGE 6

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

•

•

•

The most important organ responsible for drug excretion is the kidney (renal)

Other Methods of Excretion: »

Urine

»

Bile

»

Sweat

»

Saliva

»

Breast milk

»

Expired air

Pharmacodynamics »

The study of what medications do to the body and how they do it

»

Drugs interact with receptors to produce effects

Receptors »

Different receptors act through different nervous systems and exhibit similar responses

•

A receptor agonist or antagonist is often related to the drug’s indication and mechanism of action

•

Factors Affecting Response to Medication: »

Age

»

Body mass

»

Pre-existing conditions

»

Gender PAGE 7

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

Environment and time of administration

•

Drug Formularies

•

MFRs are authorized to administer or assist in the administration of certain medications:

•

•

»

Aspirin

»

Epinephrine

»

Ventolin

»

Atrovent

»

Naloxone

Oxygen: »

Oxygen is considered a drug.

»

Has a formulary

Drug Formulary Sections »

Generic name

»

Trade name

»

Class

»

Mechanism of action

»

Indications

»

Contraindications

»

Precautions

»

Adverse effects

»

Dose & route

»

Supply PAGE 8

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

•

•

•

Indications »

Reasons to give the drug

»

Based on signs and symptoms, SAMPLE history, and vital signs

Contraindications »

Reasons to not give the drug

»

May cause more harm than good

Adverse Effects »

Usually unintended, undesired effect of the medication

»

Example: Nausea is a common side effect of many medications

Precautions »

Pre-existing conditions or vital signs that the MFR should be aware of

»

Drug administration may worsen the patient’s condition

Dose »

Amount required to achieve the desired effect

»

Common measurements include: • mg •

mcg

•

g

•

ml PAGE 9

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

•

Route: »

How the drug is administered

»

Affects how quickly the drug enters the patient’s circulation and is absorbed

»

Assisted vs. administered

Assisted Medications »

Epipen (IM-intramuscular)

»

Ventolin (MDI-metered dose inhaler)

»

Atrovent (MDI-metered dose inhaler)

»

Naloxone (IM-intramuscular)

Assisted Medications: Example »

•

•

These drugs are assisted because they are prescribed to the patient for a certain medical condition (anaphylaxis, asthma, etc.)

Administered »

Aspirin (PO: chewed orally)

»

Oral glucose (PO: absorbed and swallowed orally)

Ensuring Safety »

Before drug administration, the MFR must check: •

Vital signs

•

SAMPLE history

•

5 R’s, 3 C’s, 1 E PAGE 10

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

The 5 Rights of Medication »

Right Dose

»

Right Drug

»

Right Patient

»

Right Route

»

Right Time •

6th is the right documentation

•

7th is the right to refuse

The 3 C’s of Medication: »

Colour

»

Concentration

»

Clarity

•

The 1 E of Medication: Expiration date

•

Reassessment: »

After drug administration, the MFR must check: •

The patient’s response to the drug •

•

The patient’s vital signs •

•

within 5 minutes

every 5 minutes

OPQRST if it applies

PAGE 11

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

•

Epinephrine Auto-injector »

Specific doses, indications, and contraindications are included in the MFR Drug Reference Guide

»

MFRs may assist with the injection if the patient is having a severe reaction and is unable to inject themselves

»

MFRs are to activate EMS if not already done so

»

If symptoms of anaphylaxis persist despite the use of an auto-injector, the MFR should seek medical advice before assisting with the second injection

Epinephrine Auto-injector Procedure »

Ensure EMS responding

»

Check expiration date

»

Inspect contents to determine if there is discolouration or particles

»

Unscrew the cap

»

Remove the auto-injector from case

»

Grasp the injector with your hand, holding the black tip downward

»

Remove the blue release cap, while taking care to avoid touching the yellow tip or black tip

»

Hold for 5-10 seconds

Sharps: »

Dispose of the sharp needle in the carrying case

PAGE 12

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

Recap the carrying case

»

Re-assess the patient

MFR Specific Medications •

•

Oral Glucose: »

Oral glucose is supplied as a tube of gel

»

Each tube contains 31g of glucose

»

Not possible to squeeze out entire contents of tube, so typical dose is 25g

»

Ensure EMS responding

»

Ensure patient has an intact gag reflex

»

Check expiration date

»

Twist cap off of oral glucose tube

»

Insert tube between cheek and gum and squeeze appropriate dose, (25g), taking care not to cause an airway obstruction

»

Ask patient to swallow medication

»

Observe and reassess patient for improvement

»

Repeat every 5 minutes if no improvement noted

»

Maximum dose is 50g (two tubes)

ASA Administration: »

Specific doses, indications, and contraindications for administration of ASA are included in the MFR Drug Reference Guide

PAGE 13

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

Ensure EMS responding

»

Confirm chief complaint is chest pain

»

Rule out contra-indications for ASA usage: •

•

»

Give patient two 81 mg tablets and tell patient to chew and swallow them

»

Record time of ASA administration

»

Complete a full set of vital signs including blood pressure

Salbutamol (Ventolin): »

»

» •

Allergy, bleeding ulcers, hemophilia, third trimester pregnancy, etc.

Mechanism of Action: •

Selectively stimulates beta-adrenergic receptors of the lungs, uterus, and vascular smooth muscle

•

Bronchodilation results from relaxation of the vascular smooth muscles, which relieves bronchospasm and reduces airway resistance

Indications •

Bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchopulmonary disorders

•

Respiratory distress with bronchospasm

Contraindications:

Hypersensitivity

PAGE 14

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

»

Precautions / Interactions: •

Use with caution in tachycardia’s

•

Should not be used with patients presenting with acute heart failure

•

Cardiovascular disease: cardiac dysrhythmias, hypertension

•

Diabetes mellitus: risk of drug-induced hyperglycemia

•

Hypokalemia: risk further reducing serum potassium levels and possible adverse cardiovascular

Dosage: •

•

Adult: •

MDI: Minimum 6 puffs; maximum 20

•

NEB: 2.5 – 5.0 mg nebule – repeat q 10 minutes prn

Pediatric: •

MDI: Minimum 2 puffs; maximum 10

•

NEB: 0.15 mg/kg diluted to 2.5 ml saline via nebulizer, or

•

< 10 kg: 2.5 ml

•

10 - 20 kg: give 2.5 mg

•

> 20 kg:

give 1.25 mg with NS to

give 2.5 – 5.0 mg

PAGE 15

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

•

Administration: •

Shake container several times

•

Have patient exhale deeply

•

Have patient place his/her lips around the opening of the inhaler

•

Have the patient depress the handheld inhaler when beginning to inhale deeply

•

Instruct patient to hold breath for as long as is comfortable

•

Allow patient to breathe a few times and repeat with second dose

•

If the patient has a spacer device it should be used

•

Provide oxygen as appropriate

Ipratropium (Atrovent): »

Mechanism of Action: •

»

»

Inhibits cholinergic receptors in the bronchial smooth muscle, resulting in bronchodilation

Indications: •

Bronchospasm from asthma,

•

Chronic bronchitis, emphysema

Ipratropium: •

Contraindications: •

Atropine, aerosol propellants, patients with soy or peanut allergies PAGE 16

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

»

Precautions / Interactions: •

Use with patients with narrow angle glaucoma, prostatic hypertrophy, urinary retention

•

Hypersensitivity to soy lecithin with caution or related food products (soybeans, peanuts)

•

Patients with narrow angle glaucoma

•

Be careful to avoid accidental release into the eyes (use mouthpiece neb if possible)

Dosage: •

Adult: •

•

•

Pediatric: (ages 5 - 11) •

*Note: Safety and efficacy in children under 12 years of age hasn’t been established.

•

MDI: Minimum 2 puffs prn; maximum 4

For both adult and pediatric: •

»

MDI: Minimum 1 - 4 puffs prn; maximum 10 (20 mcg/spray)

Give after salbutamol; ipratropium has a much slower onset of action

Nebulized Doses: •

Adults: 250 – 500 mcg via nebulizer with salbutamol (mixed); repeat up to two times if necessary PAGE 17

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

•

•

*Note: Normally only 1 - 2 doses in other conditions (eg. emphysema, chronic bronchitis); Combivent: 2.5 – 5.0 ml nebule; repeat q 10 minutes prn (not to exceed maximum dose for Atrovent )

•

Pediatrics: 25 - 250 mcg via nebulizer with salbutamol (mixed); repeat up to two times if necessary

Naloxone: »

Administration: •

»

Definitions: •

Opioid: A substance that acts upon the opioid receptors in the body

•

Opiate: Alkaloid substances derived from the opium poppy plant

The Facts: •

Within the first 3 months of 2016, there were 69 opioid-related deaths in Alberta.

•

Opioid overdose deaths in Alberta, previous years: •

2011

6

•

2012

29

•

2013

66

•

2014

120

•

2015

274

PAGE 18

EMR LECTURE NOTES OUTCOME 6 EMERGENCY MEDICAL RESPONDER

»

»

»

•

In May 2016, Alberta became the second province in Canada to provide naloxone to residents without prescription.

•

Albertans at risk and people with a close relationship to these individuals can now go to their local pharmacy to request naloxone kits free of charge.

Objectives: •

Define opioid

•

Describe the signs and symptoms of opioid overdose

•

Identify the opioid antagonist naloxone

•<...