question

List the drugs in your scope of practice

answer

aspirin, oral glucose, oxygen, prescribed bronchodilator inhalers, nitroglycerin, and epinephrine auto-injectors.

question

Route(s) of administration

answer

• Oral, or swallowed. This route is very safe and has few complications associated with administration. • Sublingual, or dissolved under the tongue. This route also accesses the body through the mouth; however, in this case the medication is typically placed under the tongue and allowed to dissolve. • Sublingual, or dissolved under the tongue. This route also accesses the body through the mouth; however, in this case the medication is typically placed under the tongue and allowed to dissolve. • Intravenous, or injected into a vein. The intravenous route is beyond the scope of the EMT level. • Intramuscular, or injected into a muscle. The intramuscular route injects medication directly into the muscle. • Subcutaneous, or injected under the skin. Subcutaneous injections are very similar to intramuscular injections except that they deliver medications into the layers of the skin rather than into the muscle. • Endotracheal, or sprayed directly into a tube inserted into the trachea. This route is used in some ALS systems.

question

pharmacology

answer

The study of drugs, their sources, their characteristics, and their effects.

question

Generic and common trade names (p. 431)

answer

Each drug is listed by its generic name (a general name that is not the brand name of any manufacturer). However, each drug actually has at least three names: the chemical name, the generic name, and one or more trade (brand) names given the drug by various manufacturers.

question

U.S. Pharmacopoeia (USP)

answer

Every drug or medication is listed in a comprehensive government publication

question

generic name

answer

a general name that is not the brand name of any manufacturer

question

each drug actually has at least three names:

answer

the chemical name, the generic name, and one or more trade (brand) names given the drug by various manufacturers.

question

epinephrine

answer

is a generic drug name for epinephrine

question

B-(3, 4 dihydroxyphenyl)-a-methylaminoethanol

answer

chemical name name for epinephrine

question

Chemical names

answer

are technical formulas used only by scientists or manufacturers.

question

Epi-Pen®

answer

is the trade name of an epinephrine auto-injector.

question

Indications

answer

specific signs, symptoms, or circum-stances under which it is appropriate to administer the drug to a patient.

question

nitro-glycerin

answer

is indicated when a patient has chest pain or squeezing, dull pressure.

question

contraindications

answer

or specific signs, symptoms, or circumstances under which it is not appropriate, and may be harmful, to administer the drug to the patient.

question

nitroglycerin

answer

is contraindicated (should not be given) if the patient has low blood pressure, Contraindicated in dilating the arteries, causes a slight drop in the systolic blood pressure.

question

side effect

answer

any action of a drug other than the desired action.

question

untoward effect

answer

an effect of a medication in addition to its desired effect that may be potentially harmful to the patient.

question

parenteral

answer

referring to a route of medication administration that does not use the gastrointestinal tract, such as an intravenous medication.

question

enteral

answer

referring to a route of medication administration that uses the gastrointestinal tract, such as swallowing a pill.

question

The role of medical direction in medication administration

answer

As an EMT you are authorized to administer medications by your Medical Director. This Medical Director may be service level, regional level, or even state level. The authorization to administer medications can come in two different manners: Off-line medical direction & On-line medical direction.

question

authorization to administer medications

answer

Off-line medical direction & On-line medical direction.

question

Off-line medical direction

answer

Uses "standing orders"; that is, orders written down in the form of protocols. Providers learn these protocols and administer medications guided by the specific circumstances and conditions previously outlined in their rules and regulations. Not actually speaking to a physician to ask permission.

question

On-line medical direction

answer

Speaking to a physician. Use of this process significantly reduces medication errors. If at any time you are confused or have a question, speak up. Asking for clarification while on-line always is appropriate. A useful technique to employ is the "echo technique." In this technique, you will listen to the order and then repeat the order back. The physician then should give you a verbal confirmation that what you have heard is correct.

question

Medications come in many different forms

answer

• Compressed powders or tablets, such as nitroglycerin pills. • Liquids for use outside the digestive tract, such as in an injection.This route is called the parenteral route and refers to bypassing the GI tract. An example of this type of medication would be epinephrine from an auto-injector. • Liquids to be taken orally (like a cough syrup). This route utilizes the digestive tract to reach the bloodstream and is known as an enteral route. • Liquid that is vaporized, such as a fixed-dose nebulizer. • Gels, such as the paste in a tube of oral glucose. • Suspensions, such as the thick slurry of activated charcoal in water. • Fine powder for inhalation, such as that in a prescribed inhaler. • Gases for inhalation, such as oxygen. • Sublingual (under-the-tongue) sprays such as a nitroglycerin spray.

question

The Five Rights

answer

• Do I have the right patient? Does this medication belong to the patient? Is this the same patient medical direction approved a medication order for? • Is it the right time to administer this medication? Have I made the right decision to administer the medication based on what I am seeing? Is it appropriate under these circumstances to give this particular medication? • Is this the right medication? Did I pick up the right bottle? Am I sure this is the correct medication? • Is this the right dose? Have I double checked? Am I sure I am giving the correct amount? • Am I giving this medication by the right route of administration?

question

The Five Rights

answer

• right patient? • right time to administer this medication? • right medication? • right dose? • right route of administration?

question

Routes of Administration

answer

Oral Sublingual Inhaled Intravenous

question

Oral Route

answer

are typically given in pill or capsule form; however, liquids are also a possible option. Patients simply swallow the medication.This route is very safe and has few complications associated with administration. However, since the medication must be digested to take effect, it also takes longer for the medication to become effective. ORAL MEDICATIONS are given in chewable pill form (such as aspirin), since water for swallowing pills is often not available.

question

Sublingual Route

answer

is dissolved under the tongue. accesses the body through the mouth; however, in this case the medication is typically placed under the tongue and allowed to dissolve. As it dissolves, the medication is absorbed by the vascular soft tissue of the mouth. This route is faster than swallowing pills, but absorption sometimes is difficult if circulation is poor (as in shock).

question

Inhaled Route

answer

breathed into the lungs, usually as tiny aerosol particles (such as from an inhaler) or as a gas (such as oxygen). Inhaled medications are breathed in through the respiratory system, and the medication is absorbed into the bloodstream through the alveoli. This is typically a simple process of putting a mask on your patient (as with oxygen). However, inhaled medications can be delivered via inhalers or nebulizers as well.

question

Intravenous Route

answer

is beyond the scope of the EMT level. However, you should know that this is a fast and precise way to administer medications into the body by directly accessing the bloodstream through a vein.

question

Intramuscular route

answer

injects medication directly into the muscle.There, blood vessels can rapidly absorb the medication and transfer it to other parts of the body. This method of administration is very fast and allows for the effects of medication to rapidly occur. It can, however, be affected by poor circulation (as in shock) and also has a much higher complication rate than the oral or sublingual routes. This route typically uses a needle, as in an auto-injector, to deliver the medication.

question

Interventions

answer

Once you move the patient be sure to recheck. Slow is Smooth and Smooth is Fast.

question

Subcutaneous Injections

answer

are very similar to intramuscular injections except that they deliver medications into the layers of the skin rather than into the muscle.This results in a slightly slower absorption than with intramuscular injections.

question

Intraosseous Injections

answer

injected into the bone marrow cavity. New technology (the "IO gun" or "IO drill") allows rapid placement of a rigid needle into the bone marrow cavities of long bones such as the tibia.This technology, with compelling research that shows medications and fluids injected into the marrow reach the central circulation as fast as those given IV, has made the IO route popular among ALS providers and emergency physicians in emergency situations such as cardiac arrests.

question

Endotracheal Route

answer

sprayed directly into a tube inserted into the trachea. This route is used in some ALS systems. Endotracheal medications are administered through a tube inserted into the trachea to be absorbed by the tissue of the lungs. Recent evidence has questioned the effectiveness of this route, however, because lung tissue has very unpredictable absorption rates. Yet you may find this route still used as a last resort.

question

Pharmacodynamics

answer

is the study of the effects of medications on the body. It is important to consider pharmacodynamics anytime you administer a medication. You should ask questions like: What effect will this medication have? How will it affect my patient? Remember that patient-specific factors can change how a medication will work.

question

IV therapy

answer

is an advanced life support procedure. In this procedure, an intravenous (IV) catheter is inserted into a vein so that blood, fluids, or medications can be administered directly into the patient's circulation.

question

two ways fluids and medications may be administered into the vein

answer

a heparin or saline lock

question

a heparin or saline lock

answer

can be used when fluid is not likely to be administered but medication administration or IV access may be needed later on. a catheter is placed into the vein. A small cap or lock is placed over the end of the catheter that protrudes from the skin. This lock contains a port through which you can administer medication.

question

the traditional IV bag

answer

This hangs above the patient and constantly flows fluids and medications into the patient. The bag of fluid that feeds the IV is usually a clear plastic bag that collapses as it empties. The administration set is the clear plastic tubing that connects the fluid bag to the needle, or catheter.

question

The three parts of the clear plastic tubing that connects the fluid bag to the needle, or catheter:

answer

The drip chamber The flow regulator The drug or needle port

question

The drip chamber

answer

Is near the fluid bag. There are two basic types: the micro drip (also sometimes called mini drip) and the macro drip. The micro drip is used when minimal flow of fluid is needed (with children, for example). For example, 60 small drops from the tiny metal barrel in the drip chamber equal 1 cubic centimeter (cc) or 1 milliliter (mL). The macro drip is used when a higher flow of fluid is needed (for a multitrauma patient in shock, for example). There is no little barrel in the drip chamber of the macro drip, and just 10 to 15 large drops equal 1 cc or 1 mL.

question

the micro drip

answer

(also sometimes called mini drip) is used when minimal flow of fluid is needed (with children, for example). For example, 60 small drops from the tiny metal barrel in the drip chamber equal 1 cubic centimeter (cc) or 1 milliliter (mL).

question

The macro drip

answer

is used when a higher flow of fluid is needed (for a multitrauma patient in shock, for example). There is no little barrel in the drip chamber of the macro drip, and just 10 to 15 large drops equal 1 cc or 1 mL.

question

Steps to setting up the IV administration set:

answer

1. Take out and inspect the fluid bag (Figure 18-10). The bags come in a protective wrapping to keep them clean. If you are setting up the IV, you must remove the wrapper, then inspect the bag to be sure it contains the fluid that has been ordered. Check the expiration date to make sure the fluid is usable, and look to see that the fluid is clear and free of particles. Squeeze the bag to check for leaks. Occasionally, the fluid comes in a bottle. If so, be sure it is free of cracks. If anything is wrong, report the problem and inspect another bag or bottle. 2. Select the proper administration set. Uncoil the tubing, and do not let the ends touch the ground. 3. Connect the extension set to the administration set, if an extension set is to be used. 4. Make sure the flow regulator is closed.To do this,roll the stopcock away from the fluid bag. 5. Remove the protective covering from the port of the fluid bag and the protective cover- ing from the spiked end of the tubing. Insert the spiked end of the tubing into the fluid bag with a quick twist (Figure 18-12). Do this carefully. Maintain sterility. If these parts touch the ground, they must not be used. Introducing germs or dirt directly into a pa- tient's bloodstream can be extremely serious, if not fatal. 6. Hold the fluid bag higher than the drip chamber. Squeeze the drip chamber a time or two to start the flow. Fill the chamber to the marker line (approximately one-third full). 7. Open the flow regulator and allow the fluid to flush all the air from the tubing (Figure 18-13). You may need to loosen the cap at the lower end to get the fluid to flow. Maintain the sterility of the tubing end and replace the cap when you are finished. Most sets can be flushed without removing the cap.Be sure that all air bubbles have been flushed from the tubing to avoid introducing a dangerous air embolism into the patient's vein. 8. Turn off the flow (Figure 18-14).

question

Nitrostat™, Nitrolingual®

answer

Nitroglycerin Trade name

question

Nitroglycerin of INDICATIONS All the following conditions must be met:

answer

1. Patient complains of chest pain. 2. Patient has a history of cardiac problems. 3. Patient's physician has prescribed nitroglycerin (NTG). 4. Systolic blood pressure is greater than 90 to 100 systolic. 5. Medical direction authorizes administration of the medication.

question

Nitroglycerin of CONTRAINDICATIONS

answer

1. Patient has hypotension, or a systolic blood pressure below 90 to 100. 2. Patient has a head injury. 3. Patient is an infant or child. 4. Patient has already taken the maximum prescribed dose. 5. Patient has recently taken Viagra, Cialis, Levitra, or another drug for erectile dysfunction.

question

Nitroglycerin MEDICATION FORM

answer

Tablet, sublingual (under-the-tongue) spray

question

Nitroglycerin DOSAGE

answer

One dose. Repeat in 5 minutes, if less than complete relief, if systolic blood pressure remains above 90 to 100, and if authorized by medical direction, up to a maximum of three doses.

question

Nitroglycerin ADMINISTRATION

answer

1. Perform a focused assessment for the cardiac patient. 2. Take the patient's blood pressure. (Systolic pressure must be above 90 to 100.) 3. Contact medical direction, if no standing orders. 4. Ensure the right patient, right time, right medication, right dose, and right route. Check the expiration date. 5. Ensure the patient is alert. 6. Question the patient on the last dose taken and effects. Ensure understanding of the route of administration. 7. Ask the patient to lift his tongue, and place the tablet or spray dose under the tongue (while wearing gloves) or have the patient place the tablet or spray under the tongue. 8. Have the patient keep his mouth closed with the tablet under the tongue (without swallowing) until dissolved and absorbed. 9. Recheck the patient's blood pressure within 2 minutes. 10. Record the administration, route, and time. 11. Reassess the patient.

question

Nitroglycerin ACTIONS

answer

1. Relaxes blood vessels 2. Decreases workload of heart

question

Nitroglycerin SIDE EFFECTS

answer

1. Hypotension (lowers blood pressure) 2. Headache 3. Pulse rate changes

question

Nitroglycerin REASSESSMENT STRATEGIES

answer

1. Monitor blood pressure. 2. Ask patient about effect on pain relief. 3. Seek medical direction before readministering. 4. Record assessments.

question

Generic name

answer

aspirin

question

Trade name

answer

many available

question

aspirin INDICATIONS All of the following conditions must be met:

answer

1. Patient complains of chest pain. 2. Patient is not allergic to aspirin. 3. Patient has no history of asthma. 4. Patient is not already taking any medications to prevent clotting. 5. Patient has no other contraindications to aspirin. 6. Patient is able to swallow without endangering the airway. 7. Medical direction authorizes administration of the medication.

question

aspirin CONTRAINDICATIONS

answer

1. Patient is unable to swallow without endangering the airway. 2. Patient is allergic or sensitive to aspirin. 3. Patient has a history of asthma (many people with asthma are allergic to aspirin). 4. Patient has gastrointestinal ulcer or recent bleeding. 5. Patient has a known bleeding disorder. 6. Medical direction may decide if the benefit of giving aspirin to a patient who has one of the following conditions outweighs the risk: a. Is already taking medication to prevent clotting (including aspirin) b. Pregnancy c. Recent surgery

question

aspirin MEDICATION FORM

answer

Tablet; many EMS systems use baby aspirin, usually supplied as 81 mg chewable tablets.

question

aspirin DOSAGE

answer

162 to 324 mg (two to four 81 mg tablets of chewable baby aspirin). Aspirin does not usually need to be administered more than once in the early treatment of cardiac problems.

question

aspirin ADMINISTRATION

answer

1. Gather a history and perform a physical exam appropriate for a cardiac patient. 2. Contact medical direction, if no standing orders. 3. Ensure the right medication, right patient, right time, right dose, and right route. Check the expiration date. 4. Ensure the patient is alert. 5. Ask the patient to chew (if directed by protocol) and swallow tablets. 6. Record the administration, route, and time. 7. Perform reassessment.

question

aspirin ACTIONS

answer

1. Prevents blood from clotting as quickly, leading to increased survival after myocardial infarction. 2. When administered to cardiac patients, aspirin is not being used to relieve pain.

question

aspirin SIDE EFFECTS

answer

1. Nausea 2. Vomiting 3. Heartburn 4. If patient is allergic, bronchospasm and wheezing 5. Bleeding

question

aspirin REASSESSMENT STRATEGIES

answer

1. Perform reassessment. 2. Evaluate the patient for new onset of difficulty breathing from bronchospasm. 3. Any bleeding resulting from the aspirin is very unlikely to occur before the patient arrives at a hospital. 4. Record the assessments.

question

Oral Glucose MEDICATION NAME

answer

Oral Glucose

question

Oral Glucose Generic name

answer

Glucose, oral

question

Oral Glucose INDICATIONS

answer

Patients with altered mental status and a known history of diabetes mellitus

question

Oral Glucose CONTRAINDICATIONS

answer

1. Unconsciousness 2. Known diabetic who has not taken insulin for days 3. Unable to swallow

question

Oral Glucose MEDICATION FORM

answer

Gel, in toothpaste-type tubes

question

Oral Glucose DOSAGE

answer

One tube (Whole Tube)

question

Oral Glucose ADMINISTRATION

answer

1. Ensure signs and symptoms of altered mental status with a known history of diabetes. 2. Ensure patient is conscious. 3. Administer glucose. a. Place on tongue depressor between cheek and gum, or b. Have patient self-administer between cheek and gum. 4. Perform reassessment.

question

Oral Glucose ACTIONS

answer

Increases blood sugar

question

Oral Glucose SIDE EFFECTS

answer

None when given properly. May be aspirated by the patient without a gag reflex.

question

Oral Glucose REASSESSMENT STRATEGIES

answer

If patient loses consciousness or seizes, remove tongue depressor from mouth.

question

Oral Glucose Trade name

answer

Glutose, Insta-glucose

question

Prescribed Inhaler MEDICATION NAME

answer

1. Generic: albuterol, isoetharine, metaproterenol 2. Trade: Proventil, Ventolin, Bronkosol, Bronkometer, Alupent, Metaprel

question

Prescribed Inhaler INDICATIONS Meets all the following criteria:

answer

1. Patient exhibits signs and symptoms of respiratory emergency. 2. Patient has physician-prescribed handheld inhaler. 3. Medical direction gives specific authorization to use.

question

Prescribed Inhaler CONTRAINDICATIONS

answer

1. Patient is unable to use the device (e.g., not alert). 2. Inhaler is not prescribed for the patient. 3. No permission has been given by medical direction. 4. The patient has already taken the maximum prescribed dose prior to the EMT's arrival.

question

Prescribed Inhaler MEDICATION FORM

answer

Handheld metered-dose inhaler.

question

Prescribed Inhaler DOSAGE

answer

Number of inhalations based on medical direction's order or physician's order.

question

Prescribed Inhaler ADMINISTRATION

answer

1. Obtain an order from medical direction, either on-line or off-line. 2. Ensure the right patient, right time, right medication, right dose, right route, and patient is alert enough to use the inhaler. 3. Check the expiration date of the inhaler. 4. Check if the patient has already taken any doses. 5. Ensure the inhaler is at room temperature or warmer. 6. Shake the inhaler vigorously several times. 7. Have the patient exhale deeply. 8. Have the patient put her lips around the opening of the inhaler. 9. Have the patient depress the handheld inhaler as she begins to inhale deeply. 10. Instruct the patient to hold her breath for as long as she comfortably can so the medication can be absorbed. 11. Put the oxygen back on the patient. 12. Allow the patient to breathe a few times and repeat the second dose if so ordered by medical direction. 13. If the patient has a spacer device for use with her inhaler (device for attachment between inhaler and patient to allow for more effective use of medication), it should be used.

question

Prescribed Inhaler ACTIONS

answer

Beta-agonist bronchodilator dilates bronchioles, reducing airway resistance.

question

Prescribed Inhaler SIDE EFFECTS

answer

1. Increased pulse rate 2. Tremors 3. Nervousness

question

Prescribed Inhaler REASSESSMENT STRATEGIES

answer

1. Gather vital signs. 2. Perform a focused reassessment of the chest and respiratory function. 3. Observe for deterioration of the patient; if breathing becomes inadequate, provide artificial respirations.

question

Epinephrine Auto-Injector

answer

MEDICATION NAME 1. Generic: epinephrine 2. Trade: Adrenalin™ 3. Delivery system: EpiPen® or EpiPen Jr.® or Twinject® (adult or child size)

question

Epinephrine Auto-Injector INDICATIONS Must meet the following three criteria:

answer

1. Patient exhibits signs of a severe allergic reaction, including either respiratory distress or shock (hypoperfusion). 2. Medication is prescribed for this patient by a physician or is carried on the ambulance. 3. Medical direction authorizes use for this patient.

question

Epinephrine Auto-Injector CONTRAINDICATIONS

answer

No contraindications when used in a life-threatening situation.

question

Epinephrine Auto-Injector MEDICATION FORM

answer

Liquid is administered by an auto-injector—an automatically injectable needle-and-syringe system.

question

Epinephrine Auto-Injector DOSAGE

answer

1. Adult: one adult auto-injector (0.3 mg) 2. Infant and child: one infant/child auto-injector (0.15 mg)

question

Epinephrine Auto-Injector ADMINISTRATION

answer

1. Obtain patient's prescribed auto-injector. Ensure: a. Prescription is written for the patient who is experiencing the severe allergic reaction or your protocols permit carrying the auto-injector on the ambulance. b. Medication is not discolored (if visible). c. Medication has not expired. 2. Obtain an order from medical direction, either on-line or off-line. 3. Remove the safety cap(s) from the auto-injector. 4. Grasp the center of the auto-injector (to avoid accidentally injecting yourself). 5. Place the tip of the auto-injector against the patient's thigh. a. Lateral portion of the thigh b. Midway between waist and knee 6. Push the injector firmly against the thigh until the injector activates. 7. Hold the injector in place until the medication is injected (at least 10 seconds). 8. Record the administration and time. 9. Dispose of a single-dose injector, such as the EpiPen®,in a biohazard container; save a two-dose injector, such as the Twinject®, and transport it with the patient in case the second dose is later required.

question

Epinephrine Auto-Injector ACTIONS

answer

1. Dilates the bronchioles 2. Constricts blood vessels 3. Makes the capillaries less permeable (leaky)

question

Epinephrine Auto-Injector SIDE EFFECTS

answer

1. Increased heart rate 2. Pallor 3. Dizziness 4. Chest pain 5. Headache 6. Nausea 7. Vomiting 8. Excitability, anxiety

question

Epinephrine Auto-Injector REASSESSMENT STRATEGIES

answer

1. Transport. 2. Continue secondary assessment of airway, breathing, and circulatory status. If the patient's condition continues to worsen (decreasing mental status, increasing breathing difficulty, decreasing blood pressure): a. Obtain medical direction for an additional dose of epinephrine b. Treat for shock (hypoperfusion) c. Prepare to initiate basic life support procedures (CPR, AED) If the patient's condition improves, provide supportive care: a. Continue oxygen b. Treat for shock (hypoperfusion)

question

CTAB

answer

Clear to Auscualtation Bilateraly

question

PATHOPHYSIOLOGY of Asthma

answer

Small airways become reactive and constrict. Air does not move in and out easily although exhaling is more difficult. This results in air trapping. Upon auscultation of a full respiratory cycle, you will notice that the expiratory phase is prolonged. "Triggers" such as exercise, allergens, respiratory viruses, and even aspirin and non-steroidal antiinflammatory drugs (NSAIDs) cause this reaction.

question

ACTION OF MEDICATIONS against Asthma

answer

Albuterol is a medication very commonly used during asthma attacks. It is available in an inhaler and in a small volume nebulizer (SVN). Albuterol must actually enter the smaller airways—it acts upon contact. Albuterol acts on the (beta2) receptors of the sympathetic nervous system, which results in dilation of the airways. The fact that albuterol acts primarily on the specific receptors means there will be limited cardiac side effects (such as rapid heart rate).

question

PATHOPHYSIOLOGY of Anaphylaxis

answer

Anaphylaxis is a life-threatening response of the immune system. Anaphylaxis affects major systems such as the circulatory and respiratory systems and, if untreated, can cause death. Anaphylaxis begins when the body overreacts to an antigen. Common causes of anaphylaxis are bee stings, peanut butter, and medication allergies. The allergic reaction (begun when an antigen meets antibodies within the body) causes the body to release a variety of substances, including histamine, which cause vasodilatation and shock as well as bronchoconstriction. These substances also alter vascular permeability, allowing fluid to enter and swell the airways, lips, tongue, and throat.

question

ACTION OF MEDICATIONS against Anaphylaxis

answer

The epinephrine auto-injector carried by patients and on many ambulances provides immediate and significant benefit to those suffering from anaphylaxis. Epinephrine causes vasoconstriction (which reverses shock) by acting on the alpha receptors of the sympathetic nervous system. It reduces vascular permeability and the edema found in the face and airways. Epinephrine also causes bronchodilation to open constricted bronchioles through the beta receptors in the sympathetic nervous system.

question

Advair™

answer

is a medication that may be prescribed to a patient for daily management of a respiratory disease. It should not be used for emergency treatment of an acute attack or breathing difficulty.

question

Physician's Desk Reference or PDR

answer

It is a good idea to have a resource from which you can find out additional information about a patient's medications en route to the hospital. Many ambulances carry a

question

ANALGESICS:

answer

DRUGS PRESCRIBED FOR PAIN RELIEF

question

ANTIDYSRHYTHMICS

answer

DRUGS PRESCRIBED FOR HEART RHYTHM DISORDERS

question

ANTICONVULSANTS

answer

DRUGS PRESCRIBED FOR PREVENTION AND CONTROL OF SEIZURES

question

ANTIHYPERTENSIVES

answer

DRUGS PRESCRIBED TO REDUCE HIGH BLOOD PRESSURE

question

BRONCHODILATORS

answer

DRUGS THAT RELAX THE SMOOTH MUSCLES OF THE BRONCHIAL TUBES. THESE MEDICATIONS PROVIDE RELIEF OF BRONCHIAL ASTHMA AND ALLERGIES AFFECTING THE RESPIRATORY SYSTEM

question

ANTIDIABETIC AGENTS

answer

DRUGS PRESCRIBED TO DIABETIC PATIENTS TO CONTROL HYPERGLYCEMIA (HIGH BLOOD SUGAR)

question

ANTIDEPRESSANT AGENTS

answer

DRUGS PRESCRIBED TO HELP REGULATE THE EMOTIONAL ACTIVITY OF THE PATIENT TO MINIMIZE THE PEAKS AND VALLEYS IN THEIR PSYCHOLOGICAL AND EMOTIONAL STATE

question

Herbal Agents and What They Are Sometimes Used For

answer

Gingko or gingko biloba Dementia, poor circulation to the legs, ringing in the ears St. John's wort Depression Echinacea Prevention and treatment of the common cold Garlic High cholesterol Ginger root Nausea and vomiting Saw palmetto Swollen prostate Hawthorn leaf or flower Heart failure Evening primrose oil Premenstrual syndrome Feverfew leaf Migraine prevention Kava kava Anxiety Valerian root Insomnia

question

IV therapy

answer

is an advanced life support procedure. In this procedure, an intravenous (IV) catheter is inserted into a vein so that blood, fluids, or medications can be administered directly into the patient's circulation.

question

A saline or heparin lock

answer

can be used when fluid is not likely to be administered but medication administration or IV access may be needed later on.

question

Name the drugs that are commonly carried on the ambulance and may be administered by the EMT under certain circumstances.

answer

Aspirin, oxygen, and oral glucose are medications that are commonly carried on ambulances and may, in certain circumstances, be administered by an EMT.

question

Name the drugs that the EMT may assist the patient in taking if they have been prescribed for him and with approval by medical direction.

answer

Bronchodilator inhalers, nitroglycerin, and epinephrine auto-injectors are medications for which EMTs can commonly assist with patient administration.

question

Medications may take the form of tablets. Name several other forms in which medications may appear.

answer

Other forms of medications are powder, liquids, gels, sublingual sprays, and inhaled gases.

question

Describe the difference between on-line medical direction and off-line medical direction. Provide examples of each.

answer

On-line medical direction implies speaking directly to a physician, as in calling a doctor on the radio from an emergency scene. Off-line medical direction indicates physician involvement "behind the scenes," such as in the development of guidelines and protocols.

question

Name several routes by which medications may be administered.

answer

Medications may be administered orally, administered sublingually, inhaled, injected, or even absorbed through the skin.

question

What additional patient history should you obtain?

answer

Additional patient history questions might include: • How long has the pain been going on? • Have you ever had this pain before? • Do you have any medical history? • Do you take any medications? • When was your last meal?

question

Should you let the patient take nitroglycerin? Why, or why not?

answer

Nitroglycerin might be helpful if the patient has it prescribed to him. Depending on your local protocol, you may need to contact medical control before making the decision. Always consider the five rights of medication administration before administering it.

question

Are vital signs important if nitroglycerin is going to be taken by the patient?

answer

Assessing the patient's vital signs before administering a medication is essential. Nitroglycerin, especially, can cause a drop in the patient's blood pressure, so it is very important to assure the patient's pressure is not already low before giving the medication.

question

What information do you want to know about the nitroglycerin?

answer

You want to know that the medication is prescribed to the patient, that it is not expired, and that the correct dose can be safely administered.

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How should the nitroglycerin be administered?

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When administering nitroglycerin in tablet form, one tablet should be placed under the patient's tongue until it dissolves. The tablet should not be chewed or swallowed. When administering the spray, do not shake the canister before use; hold it upright, ask the patient to open his mouth, and press the button once with your index finger. Ask the patient to close his mouth and avoid swallowing.

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When should vital signs be taken again?

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Vital signs should be reassessed shortly after administration and every five minutes thereafter.

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Activated Charcoal vs. Syrup of Ipecac

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A traditional treatment for poisoning used to be syrup of ipecac. This orally administered drug causes vomiting in most people with just one dose. When vomiting occurs, it results, on the average, in removal of less than one-third of the stomach contents. Because ipecac is slow, is relatively ineffective, and has the potential to make a patient aspirate vomitus, it is rarely used today. one dose. When vomiting occurs, it results, on the average, in removal of less than one-third of the stomach contents. Because ipecac is slow, is relatively ineffective, and has the potential to make a patient aspirate vomitus, it is rarely used today.

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Side effects

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any action of a drug other than the desired action. DESIRABLE OR UNDESIRABLE EFFECTS OF A DRUG APART FROM THE PRIMARY PURPOSE OF GIVING THE DRUG.

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untoward effects

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an effect of a medication in addition to its desired effect that may be potentially harmful to the patient.

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Downers

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have a depressant effect on the central nervous system. This type of drug may be used as a relaxing agent, sleeping pill, or tranquilizer. Barbiturates are an example, usually in pill or capsule form. One example of a downer that you may encounter on an EMS call is Rohypnol (flunitrazepam), also known as Roofies. Because it is colorless, odorless, tasteless, and has been put into unsuspecting people's drinks, it has become known as a "date rape" drug.Another downer you may see is GHB (gamma-Hydroxybutyrate), also known as Georgia Home Boy or goop. In addition to depressing the central nervous system, it produces a sense of euphoria and sometimes hallucinations. It has caused respiratory depression so severe that patients have required assisted ventilations even though some of them were still breathing.

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Narcotics

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are drugs capable of producing stupor or sleep. They are often used to relieve pain. Many drugs legitimately used for these purposes (such as codeine) are also abused, affecting the nervous system and changing many of the normal activities of the body, often producing an intense state of relaxation or feeling of well-being. A relatively new narcotic, OxyContin (oxycodone), has become a common drug of abuse. This is unfortunate, because it has done an excellent job of controlling chronic pain in patients with certain conditions. Illegal narcotics such as heroin are also commonly abused. Heroin is often injected into a vein. Other narcotics are typically in pill form. Narcotic overdoses are generally characterized by three signs: coma (or depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respirations). Together, these are sometimes referred to as the opiate triad.

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The opiate triad.

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Narcotic overdoses are generally characterized by three signs: coma (or depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respirations). Together, these are sometimes referred to as the opiate triad.

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Hallucinogens

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such as LSD, PCP, and certain types of mushrooms are mind-affecting drugs that act on the nervous system to produce an intense state of excitement or a distortion of the user's perceptions. This class of drugs has few legal uses. They are often eaten or dissolved in the mouth and absorbed through the mucous membranes.A newer hallucinogen is ecstasy, also known as XTC, X, or MDMA (because it is methylenedioxymethamphetamine). Often taken at "rave" parties with other drugs, this hallucinogen also has the stimulant properties of uppers.

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Volatile chemicals

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produce vapors that can be inhaled. They can give an initial "rush" and then act as a depressant on the central nervous system. Cleaning fluid, glue, model cement, and solutions used to correct typing mistakes are commonly abused volatile chemicals.

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A spray device with a mouthpiece that contains an aerosol form of a medication that a patient can spray into his airway is called an

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inhaler

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The two most common side effects of bronchodilators are patient jitteriness and:

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Since many bronchodilators also have an effect on the heart,an increased heart rate and patient jitteriness are common side effects of treatment.

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If your patient has an altered mental status and a history of diabetes, you may give him:

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Oral glucose is a form of glucose that can be taken by mouth as a treatment for a conscious patient (who is able to swallow) with an altered mental status and a history of diabetes.Poorly managed diabetes often leads to low blood sugar. The brain is very sensitive to low levels of sugar,and this is commonly a cause of altered mental status.Oral glucose usually comes as a tube of gel that you can apply to a tongue depressor and place between the patient's cheek and gum or under the tongue.This allows the patient to swallow the glucose so it can be easily absorbed into the digestive tract and bloodstream, which carries it to the brain.This action may begin to reverse the patient's potentially life-threatening condition.

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Epinephrine is administered to reverse the symptoms of severe allergic reaction. It also causes an increase in the patient's heart rate. This action of the drug is known as a:

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side effect. Since epinephrine has a potent effect on the heart and vascular system,increased heart rate and blood pressure commonly occur after its administration to the patient.

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The study of drugs, their sources, characteristics, and effects is called:

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pharmacology the study of drugs, their sources, their characteristics, and their effects.

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Sublingual medications should be administered:

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under the patient's tongue

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As an EMT, you will be able to administer several medications in the field. These medications include:

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oxygen.

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A medication you can administer as an EMT for a heart attack is:

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aspirin

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Because nitroglycerin causes a slight drop in blood pressure, low blood pressure is

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a(n) contraindication to give the drug.

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There are a few medications you will carry on the ambulance, including:

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oral glucose.

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What medication should you, as an EMT, immediately administer to a 62-year-old patient who complains of chest pain and difficulty breathing?

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Oxygen

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Every drug is listed in the U.S. Pharmacopoeia by its generic name. An example of a generic name for a medication is:

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epinephrine.

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Oral glucose should NOT be used if the patient:

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is unresponsive

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The EMT may assist a patient in using epinephrine when administered:

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by autoinjector.

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Before administering nitroglycerin to a patient, you should ask if he has taken

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Viagra recently.

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Albuterol, Ventolin, and Proventil are names of prescribed medications your patient may have to treat:

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breathing difficulty.

EMT Chapter 18 General Pharmacology – Flashcards

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