EHS 2020 Pharmacology for EMS Week 3 Tutorial 2022-23 PDF

EHS 2020 Pharmacology for EMS Week 3 Tutorial :Drug Administration. Learning Outcomes At the end of this lecturer students shall be able to: 1. Recall the various drug presentations (forms) which they may encounter in practice. 2. Students shall be able to describe the various routes of...

EHS 2020 Pharmacology for EMS Week 3 Tutorial :Drug Administration. Learning Outcomes At the end of this lecturer students shall be able to: 1. Recall the various drug presentations (forms) which they may encounter in practice. 2. Students shall be able to describe the various routes of administration and their routes of administration. 2 Drug Forms Drugs come in various forms of: solids liquids gasses A limited subset of these will be available to you in clinical practice. 3  Liquid Drug Forms: Solution Syrup Suspension Elixir Fluid extract Milk Tincture Emulsion Spirits Liniments & lotions Normal Saline, Benzylpenicillin, Diazepam – Which drug forms do these constitute? 4  Solid Drug Forms: Extract Suppository Powder Pessary Pill Ointment Capsule Patch Tablet Which drugs in JRCALC (2016-2019) fall into do these forms ? 5 Gaseous Drug Forms: Vapour Gas 6 Routes of Drug Administration Route of administration affects the rate of absorption and onset of therapeutic effects. 7 Pharmacological Definitions Pharmacokinetics: The study of how the body handles a drug over a specific period Absorption Distribution Metabolism Elimination We will cover these concepts in next week's lecturers. Absorption The movement of the drug from the site of entry into the body to the bloodstream. The rate of absorption is affected by 5 main factors: 1. The route of administration 2. The solubility of the drug 3. Conditions at the site of the administration 4. The pH of the drug. 5. Concentration of the drug or its dosage 9 Distribution After absorption of the drug it is circulated throughout the body by the blood. The drug then moves out of circulation through cell membranes into certain tissues. Some drugs are restricted to special tissues of the body, whereas others, can be found in all fluids of the body. The distribution of drugs in the body is highly dependent upon plasma proteins (plasma proteins carry the majority of drugs), cardiovascular function, regional blood flow and physiological barriers e.g. the placenta 10 Metabolism After a period of time a drugs’ effect is terminated. This process is a result of breakdown into less active forms, which are more easily excreted or being excreted completely unchanged. The breakdown process takes place chiefly in the liver, although in some cases it can occur in the blood plasma, the intestinal mucosa and the kidneys. 11 Elimination After a drug is broken down, its products are excreted from the body. The major routes of excretion are the kidneys (urine), the intestines (faeces) and the lungs (exhaled air). Once the drug metabolites are formed in the liver they are excreted in bile, which is then emptied into the intestines as faeces. Others are re- absorbed into the circulation and travel to the kidneys where they are voided in the urine. 12 Factors affecting drug response Age Weight Gender Environment Route of administration Condition of the patient Genetic factors Psychological factors Putting it all together How are medication prescribed to patients within the community? What methods may paramedics administer medications to patients within the practice setting? 14 How might medications be prescribed to patients? Standing Orders: Instructions for treatment that are usually specific to a particular patient presentation May or may not require consultation with medical direction Most appropriate for life-threatening conditions that require immediate intervention One-Time Orders An order for immediate drug intervention for the treatment from medical direction Cannot repeat the order without again consulting medical direction 15 Medication Prescribed Continued As-Needed Orders Often referred to as PRN orders (Latin “pro re nata,” which means “as the situation demands”) Orders are given for a specific patient condition or physiologic parameter Commonly given for pain and abnormalities in blood pressure, heart rate, and blood sugar Other Types of Medication Orders Patients are from different places (community treatment centers, long-term care facilities, etc. These patients already have a prescription or medication administration record (MAR) Paramedic needs to administer medication that the patient’s doctor has ordered For this, they should be aware of medical abbreviation 16 Medication Prescribed Continued Communication with medical direction Must be concise and clear When an order is given the paramedic Should write it down and then read the order back to medical direction The physician should then confirm the order 17 Enteral Drug Administration Enter the bloodstream through the gastrointestinal (GI) tract Administration of oral medications Majority of medications are taken orally in a solid form (pill, tablet, or capsule) or a liquid form. Are not practical or safe to administer to patients with an altered or depressed level of consciousness Often described as PO (Latin “per os”) meaning “by mouth” 9/9/2024 DRUG ADMINISTRATION 18 Enteral Drug Administration Administration of buccal medications Buccal area—The mucous membrane on the inside of the check Safe only for conscious patients with an intact gag reflex 19 Enteral Drug Administration Administration of sublingual medications Medications applied to mucous membranes Drug can be rapidly absorbed and transported by the bloodstream Extremely fast and effective 20 Enteral Drug Administration Administration of rectal medications Not frequently used in the prehospital setting Optimal for rapidly delivering a medication to a patient who is not able to take an oral medication Medications often have a butter-like consistency. Placed in the rectum, the body temperature melts the medication into a liquid form, allowing more rapid absorption by the rectal mucosa. 9/9/2024 DRUG ADMINISTRATION 21 Parenteral Drug Administration The most common route of drug administration used by paramedics Any route of drug administration other than absorption from the GI tract A more effective route in the prehospital environment Medications given via IV line produce blood levels that are reliable and are available almost immediately The limitation is the need to have special training and equipment for drug delivery Include—an IV line, IM injection, intradermal injection, subcutaneous injection, IO infusion, transdermal/topical administration, inhalation administration, intranasal, and ET tube administration 9/9/2024 DRUG ADMINISTRATION 22 Always Remember: The '7 rights' of medication administration 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation (PCR) The 7th Right, is to ‘refuse’ 23 Parenteral Drug Administration Equipment Syringes Used for injecting fluid into or withdrawing fluid from the body Tip of the syringe attaches the needle Luer-lock syringes—Allow a needle to be screwed into the tip Non-Luer-lock syringes—the needle fits tightly on the tip Barrel contains the medication Plunger pushes the liquid medication Needles Have various parts and come in different sizes Composed of a hub, shaft, and bevel Have different gauges, which are determined by their 9/9/2024 diameter DRUG ADMINISTRATION 24 Parenteral Drug Administration Equipment Safety features Never re-sheath a needle Never remove a plastic needle sheath with the teeth Do not let needles lie around Once a needle is used, it should immediately be safely secured, sheathed, and discarded in an appropriate sharps container Ensure that sharps containers are changed before they are full Carefully consider risk versus benefit of starting an IV line or handling an exposed needle in a moving ambulance Never stick a needle and syringe in the cushion of a cot or bench of an ambulance 9/9/2024 DRUG ADMINISTRATION 25 Intra-Venous (IV) 26 Inhalation Medications Nebulizers and Metered-Dose Inhalers (MDI) Many medications of respiratory emergencies are administered via the inhalation route The most common inhaled medication is oxygen Medication administered via this route Beta2 agonist bronchodilators for respiratory distress Other medications, such as ipratropium bromide (Atrovent) Check drug reference guide or the package insert before giving medications For the indications For contraindications For precautions 9/9/2024 DRUG ADMINISTRATION 27 Inhalation Medications For respiratory problems, a metered-dose inhaler (MDI) is used on a regular basis or as needed. MDIs are usually administered by the patient using the patient’s own prescribed medications Paramedics must know how to administer via this route Medications administered by the MDI can be delivered through a mouthpiece held by the patient or by a mask 9/9/2024 DRUG ADMINISTRATION 28 Intranasal Medications Include nasal spray for congestion or solutions to moisten the nasal mucosa Rapidly absorbed, providing a more rapid onset of action than IM Performed with a mucosal atomizer device (MAD) The MAD attaches to a syringe and allows you to spray (atomize) select medications into the nasal mucosa Only a few emergency medications because of the molecular structure of drugs Require 2 to 2.5 times the dose of IV medications E.g., naloxone (Narcan), midazolam (Versed), glucagon (GlucaGen) 9/9/2024 DRUG ADMINISTRATION 29 Intramuscular Injections Intramuscular injection: The administration of medication directly into muscle tissue, where the medication is absorbed through general circulation The size of the needle depends on the location of the injection and the size of the muscle group Place a needle deep in the muscle tissue. If placed into a nerve, it can result in pain and permanent disability 9/9/2024 DRUG ADMINISTRATION 30  Intramuscular Injections Muscles used for IM injections: Deltoid—at the top of the shoulder Has a rich blood supply, allowing injected medications to be rapidly absorbed Tolerate an injection volume of 2 mL An improper IM can affect the radial nerve Thigh—vastus lateralis Place one hand on the upper thigh and one hand on the lower thigh, the area between the two hands on the anterior surface of the thigh is the correct area Tolerate an injection volume of 5 mL Preferred site for IM injections in infants 9/9/2024 DRUG ADMINISTRATION 31 Intra-Muscular (IM) 32 Intramuscular Injections Muscles used for IM injections: Hip—dorsogluteal injections The upper outer quadrant of the buttocks Should not be used in patients younger than 2 years Because of variation in the sizes of muscles in children, a ventrogluteal injection is the preferred site 9/9/2024 DRUG ADMINISTRATION 33 Subcutaneous Injections Subcutaneous Injections Subcutaneous space—the tissue between the dermis of the skin and the underlying muscle Does not tolerate a volume of injection >2 ml Injections are usually