Pharmacotherapy in CBEH - Week 2 Tutorial

Pharmacotherapy in CBEH - Week 2 Tutorial: EMT Drugs

• Objectives:
  • Study the rules and regulations for narcotics and controlled drugs in the UAE.
  • Understand EMT Basic drugs.
  • Identify various units of measurement.

Rules and Regulations

• Regulators: Health Authority Abu Dhabi (HAAD/DOH), Ministry of Health (MOH), Dubai Health Authority (DHA).
• Controlled Drugs Legislation: UAE Federal Law Number 4 (1983) and UAE Federal Law Number 14 (1995).
• Local Policy: Medical Director, Narcotic Pharmacist In-Charge, JRCALC, PHECC, Drugs Policy.

Medical Director Responsibility

• Responsible for writing prescriptions on behalf of the clinician.
• Ensures policies and procedures are safe and compliant with relevant legislation.

Paramedics Drug List in the UAE

• Different providers have varying degrees of adoption of drug lists.
• Abu Dhabi and Dubai use different formularies.
• Providers should follow employer guidelines.
• Scope of practice and local permissions must be adhered to.

Pharmacy Responsibility

• Managing daily activities related to narcotics and controlled drugs.
• Conducting yearly policy reviews (or as needed).
• Ensuring compliance with regulations in all clinical areas.
• Reporting drug consumption to HAAD.
• Reporting adverse incidents/events to HAAD.

Medications Administered by EMTs

• Aspirin
• Oxygen
• Glucose Gel
• Glucagon
• GTN
• Salbutamol
• Epinephrine (1:1,000) (including auto-injector)
• Pentrox
• Nitrous oxide & Oxygen (Entonox)
• Paracetamol
• Ibuprofen

Medication Administration

• Route:

  • Oral (PO)
  • Rectal (PR)
  • Subcutaneous (SQ)
  • Sublingual (SL)
  • Intramuscular (IM)
  • Inhalation (IN)
  • Intravenous (IV)
  • Intraosseous (IO)

• Time for Effect:

  • Oral (PO): 30-90 minutes
  • Rectal (PR): 5-30 minutes
  • Subcutaneous (SQ): 15-30 minutes
  • Sublingual (SL): 3-5 minutes
  • Intramuscular (IM): 10-20 minutes
  • Inhalation (IN): 3-5 minutes
  • Intravenous (IV): 30-60 seconds
  • Intraosseous (IO): 30-60 seconds

Units of Measurement

• 1 kilogram (kg) = 1000 grams (g)
• 1 gram (g) = 1,000,000 micrograms (mcg)
• 1 milligram (mg) = 1000 micrograms (mcg)
• 1 litre (L) = 1000 millilitres (mL)
• 1mL = 1 cubic centimeter (cc)

EMT Basic Medications

• Aspirin (ASA): Antithrombotic, inhibits thromboxane A production, reducing clot formation in myocardial infarction (MI).
• Epinephrine (1:1000): Alpha and beta adrenergic stimulant, reverses laryngeal edema and bronchospasm in anaphylaxis, and antagonises histamine effects.
• Glucagon: Glycogenolysis, converts glycogen polymers to glucose monomers, increasing plasma glucose.
• Glucose Gel: Increases blood glucose.
• GTN (Glycerol Tri-nitrate): Vasodilator, reduces venous return and heart workload, reduces blood pressure (BP). Relases nitric oxide, leading to coronary artery dilation.
• Nitrous Oxide (Entonox): Analgesic agent, CNS depressant, providing pain relief
• Oxygen: Oxygenates tissues and organs
• Paracetamol: Analgesic (pain relief) and antipyretic (fever reduction), inhibits prostaglandin synthesis.
• Salbutamol: Beta 2 agonist, causes smooth muscle relaxation, resulting in bronchodilation.
• Ibuprofen: Analgesic, antipyretic, and anti-inflammatory.
• Penthrox (Methoxyflurane): Provides rapid short-term analgesia, a non-opioid alternative to morphine.

Pre-administration Checks

• Full set of vitals.
• Allergy checks.
• Contraindication checks.
• Check for complementary therapies (homeopathy).
• Recheck indications.
• Recheck with partner.

"Six Rights" of Medication Administration

• Right patient
• Right medication
• Right dose
• Right route
• Right time
• Right documentation (PCR)
• The 7th right is to refuse

Medication Error

• Failure in any of the six rights identified as a medication error.

Dangers of Inappropriate Administration

• Anaphylactic shock
• Death
• Breathing disorders
• Gastric bleeding
• Hypotension
• Unconsciousness
• Addiction

JRCALC (2016-2019) Drugs

• Review presentations, indications, actions, dose, administration, contraindications, cautions, and side effects of EMT-basic drugs.