EMT Pharmacology ReviewAlan Batt

Clinical Educator, CCP

Pharmacology

• At the completion of this module, the student will be able to safely administer the appropriate medication and also correctly monitor medicated patients in accordance with the appropriate CPG(s) and scope of practice for an EMT.

Pharmacology

• Is the study of how medications interact with living organisms to produce a change in function.

Pharmacological Definitions• Definitions• Pharmacodynamics

• The study of how a medication acts on a living organism• The way in which a medication produces the intended

response• Also known as the mechanism of action

Theories of Drug Action

• Four mechanisms• Bind to a receptor site• Change the physical properties of cells• Chemically combine with other chemicals• Alter a normal metabolic pathway

• Medication molecules will have 1 of 2 effects when it attaches to a receptor site.

• Agonist• it will stimulate the receptor site to cause the response

• Antagonist• it may block the receptor site from being stimulated by

other chemical mediators & inhibits the normal response.

Factors affecting drug response• Age • Weight • Gender • Environment • Route of administration • Condition of the patient • Genetic factors • Psychological factors

Medications which the EMT may administer • Aspirin• Oxygen• Glucose Gel• GTN• Salbutamol • Epinephrine (1:1,000) (auto injector)• Glucagon• Nitrous oxide & Oxygen (Entonox)• Paracetamol

Presentations

Medication

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

• Time for Effect• 30 – 90 mins• 05 – 30 mins• 15 – 30 mins• 03 – 05 mins• 10 – 20 mins• 03 – 05 mins• 30 – 60 seconds• 30 – 60 seconds

Pharmacology of EMT Medications• Aspirin (ASA)• Antithrombotic.• Inhibits the formation of thromboxane A2, which

stimulates platelet aggregation and artery constriction. • This reduces clot / thrombus formation in an MI.

Pharmacology of EMT Medications (Cont.)

• Epinephrine (1:1 000)• Alpha and beta adrenergic stimulant.• Reversal of laryngeal oedema & bronchospasm in

anaphylaxis.• Antagonises the effects of histamine.

Pharmacology of EMT Medications (Cont.)

• Glucagon• Glycogenolysis.

• the conversion of glycogen polymers to glucose monomers in the liver

• Increases plasma glucose by mobilising glycogen stored in the liver.

Pharmacology of EMT Medications (Cont.)

• Glucose Gel• Increases blood glucose levels

Pharmacology of EMT Medications (Cont.)

• Glycerol Trinitrate (GTN)• Vasodilator.• Dilates systemic veins reducing venous return to the

heart (pre-load) and thus reduces the heart workload.• Reduces BP.• Releases nitric oxide which acts as a vasodilator. Dilates

coronary arteries particularly if in spasm increasing blood flow to myocardium.

Pharmacology of EMT Medications (Cont.)

• Morphine• Opiate Analgesic.• Acts on Central Nervous System to reduce pain &

anxiety.• Vasodilatation resulting in reduced pre-load to

myocardium.

Pharmacology of EMT Medications (Cont.)

• Nitrous Oxide 50% and Oxygen 50% (ENTONOX®)• Analgesic agent gas:

• CNS depressant.• Pain relief.

Pharmacology of EMT Medications (Cont.)

• Oxygen• Oxygenation of tissue/organs.

• Paracetamol• Analgesic – central prostaglandin inhibitor.• Antipyretic – prevents the hypothalamus from

synthesising prostaglandin E, inhibiting the temperature from rising further.

Pharmacology of EMT Medications (Cont.)

• Salbutamol• Beta 2 agonist.

• Causing smooth muscle relaxation• Bronchodilation.• Relaxation of smooth muscle.

Define the terms:

• Side Effects• is an effect, whether therapeutic or adverse, that is

secondary to the one intended

• Indications• is a valid reason to use a certain medication

• Contraindications• is a reason to withhold a certain medication

• Adverse Reactions• is an expression that describes harm associated with the

use of given medications at a normal dosage

Differentiate between:• Trade Name• A name used to identify a commercial product or

service, which may or may not be registered as a trademark. Also called brand name.

• Generic Name• The term "generic" has several meanings as regards

medications:• The chemical name of a drug.• A term referring to the chemical makeup of a drug rather than

to the advertised brand name under which the drug is sold.• A term referring to any drug marketed under its chemical name

without advertising.

Pre-administration Checks

• Full set of vitals• Check for allergies• Check for contraindications• Check if patient is taking complementary therapies• homeopathy

• Recheck indications• Recheck with your partner.

The '6 rights' of medication administration • Right patient• Right medication• Right dose• Right route• Right time• Right documentation (PCR)

• The 7th Right, is to ‘refuse’

A failure in any one of these “rights” is considered a

medication error

Dangers of inappropriate administration• Anaphylactic shock• Death• Breathing disorders• Gastric bleeding• Hypotension• Unconsciousness• Addiction

Aspirin

Epinephrine 1:1,000

Glucose Gel

Glucagon

GTN

Entonox

Ibuprofen

Naloxone

Oxygen

Paracetamol

Salbutamol

Formulae

(ml) administer toVol (ml)dilutent of Vol x(mg) have What you

(mg) want What you

• As per CPG• Child’s weight in kg = (Age x 3) + 7

• Calculating correct dose

Example - Paracetamol

• An EMT identifies a 3 year old requires paracetamol suspension PO• Paracetamol suspension

PO Dosage is?• 20mg/kg

• Standard Presentation• 120mg/5ml (other

250mg/5ml)

• Weight of Paediatric • (3x3)+7=16Kgs

Amount to Administer (mg)• 20mg x 16Kgs = 320mg

• Volume to administer:13.3ml 5mlx 120mg

320mg

Now you try!

4 year old child needs Paracetamol

What’s the child’s weight?(Age x 3) + 7 = ?

19kg

Dose of Paracetamol PO (suspension)is 20ml/kg

20 x 19 = ?

• 380mg is required dose

• Paracetamol comes in a 120mg in 5ml solution

• How much should we give?

15.8ml 5ml x120mg

380mg

Weight based v Age based

• Weight based • Ibuprofen• Midazolam• Naloxone• Paracetamol

• Age based• Epinephrine (1;1,000)• Glucagon • Glucose Gel• Salbutamol

A Question

• Your partner on a call draws up the medication for you to administer to a patient

• Who is legally responsible for it?

Units of Measurement

• 1 kilogram (kg) = 1000grams (g)• 1 gram (g) = 1000,000 (mcg)• 1 milligram (mg) = 1000micrograms (mcg)

• 1 litre (L) = 1000 (ml) millilitres

• You may find (cc) referred to, where 1ml equals 1cc