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ECRN Packet: Culturally Diverse Patients Geriatric Population Medications for Home Use. Condell Medical Center EMS System 2006 Site Code #10-7214-E-1206 Revised by Sharon Hopkins, RN, BSN EMS Educator. Objectives. Upon successful completion of this module, the ECRN should be able to:

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ECRN Packet:Culturally Diverse PatientsGeriatric PopulationMedications for Home Use

Condell Medical Center EMS System

2006

Site Code #10-7214-E-1206

Revised by Sharon Hopkins, RN, BSN

EMS Educator


Objectives

Upon successful completion of this module, the ECRN should be able to:

  • understand the sensitivity required when caring for a culturally diverse patient population.

  • describe the unique assessment and care necessary for the geriatric population

  • describe common medications taken by the population and potential impacts with clinical presentations


Culturally Diverse Patients

  • Differences of any kind: race, class, religion, gender, sexual preference, personal habitat, physical ability

  • Good healthcare depends on sensitivity toward these differences

  • Every patient is unique

  • Westernized medicine is not accepted by all


Culturally Diverse Patients

  • Key points

    • Individual is the “foreground”, culture is the “background”

    • Not all people identify with their ethnic cultural background

    • Respect the patient’s beliefs

    • Every patient needs to be treated equally

    • Do not force someone to have an intervention that is against their personal beliefs


Culturally Diverse Patients

  • Respect the integrity of cultural beliefs

  • Patients may not share your explanation of causes of ill health and not accept conventional treatments

  • Recognize your personal cultural assumptions, prejudices and belief systems.

  • Avoid letting your prejudices interfere with patient care


Patient Rights

  • Patients have the right to self-determination

  • If the patient is of legal age (18 or older, not emancipated), the patient has the right to refuse any care or treatment offered

  • Document what has been refused and why

  • The patient, or person authorized to consent, must sign for themselves

    • spouses, grandparents, older siblings, police officers cannot sign a refusal

    • if telephone permission is taken, witness by 2 persons, and add the name of the person supplying permission


Groups By Region

  • Many groups overlap regions

  • Older population usually refer to themselves by their ethnic region (ie: Chinese, Mexican)

  • Younger population usually refer to themselves by racial terms (ie: Asian, Latino)

  • Cannot always judge the ethnicity based on appearances - ask the patient if you need clarification


Culturally Diverse Patients

  • Locale of practice

    • get to know the predominate cultures of your area

    • the more you understand the culture, the more effective a practitioner you can be

    • know resources available in your hospital/community


Culturally Diverse Patients

  • Language barriers

    • your assessment and accuracy of interpretation will be hindered when a language barrier is present

    • if an interpreter is used, document their name and relationship

    • in some cultures, use of children is insulting to adults and seen as too much responsibility placed on the child

    • language lines are available - use them when gathering/sharing medically pertinent information


Culturally Diverse Patients And Body Language

  • Very important especially when a language barrier exists

  • Usually at a subconscious level

  • Components of body language

    • eye contact

    • facial expressions

    • proximity

    • posture

    • gestures


Body Language - Eye Contact

  • Can play a key role in establishing rapport

  • Failure to make eye contact can be a sign of dishonesty

  • Making eye contact can be a sign of disrespect in some cultures (Chinese)


Body Language - Facial Expressions

  • One of the most obvious forms of body language

  • Can convey mood, attitude, understanding, confusion, other emotions

  • Smiles are usually universally understood

  • Smiling and winking can have different connotations from a friendly gesture to flirting to disrespect (culture dependent)


Body Language - Proximity

  • Acceptability varies widely culture to culture

  • In the United States, twice the arm length is a comfortable social distance - 4-12 feet

  • Personal space is 1.5 - 4 feet

  • Different messages are interpreted when standing above, at, or below eye level

    • above eye level shows authority, can be intimidating

    • at eye level indicates equality

    • below eye level shows willingness to let patient have some control over the situation


Body Language - Posture

  • Range of attitudes conveyed from interest, respect, subordination, disrespect

  • Can replace or accompany verbal communication

  • Some cultures it is impolite to show the bottom of the shoe because it is dirty; they will not sit with a foot crossed & resting on opposite knee


Culturally Diverse Patients - Financially Challenged

  • May refuse health care due to its costs

  • We need to be an advocate for these people and make sure they are offered initial medical screening

  • Know your community and county resources to offer to this group of people

  • As a reminder, use your own resources wisely


Culturally Diverse Patients - Financially Challenged

  • Signs of impairment

    • homelessness

    • chronic illness with frequent hospitalizations

    • poor personal hygiene

    • self-employment


Resources for Referral

  • PADS - public access to provide shelter

    • provide meals and shelter October 1 - April 30

    • open 7 pm - 7 am

    • goals -

      • connect person with resources to be able to leave the street

      • commit to own effort for health and recovery

      • to gain personal and economic self-sufficiency with safe, affordable permanent housing

  • HealthReach Clinic - medical screening

    • 847-360-8800 (Waukegan)


Resources for Referral

  • Catholic Charities

    • to help families & individuals overcome tragedy, poverty, other life challenges

    • Lake County

      • adult agency 847-377-4504

      • juvenile agency 847-377-7800

  • Salvation Army 847-336-1800

  • Connection Crisis & Referral Hotline 847-689-1080

  • Department Chaplain

  • Hospital Social Worker


Geriatrics


Challenges in the Geriatric Population

  • Fear of losing autonomy/independence

    • mobility - walking and by car

    • want to continue to live on own

  • Patient fears financial burden of hospitalization

  • Patient is embarrassed by burden they become to family and friends

  • Multiple disease processes affecting health

  • Difficulty in communicating pain and fears


Challenges in Dealing With the Geriatric Population

  • Patient fatigues easily

  • Many layers of clothing hamper detailed examination

  • Need for modesty and privacy

  • May minimize their symptoms

    • fear that they may be hospitalized, illness will cost money they don’t have, illness may cause nursing home or alternate living arrangements with loss of independence


Challenges in theGeriatric Population

  • Often suffer from concurrent illnesses

  • Chronic problems make assessment of acute problems difficult

  • Aging affects response to illness/injury

  • Social/emotional factors have great impact on health

  • Depression & isolation - highest suicide rates in people over 65


Sensory Related Changes

  • Vision

    • cataracts cause blurring of vision; unable to distinguish between blue & purple

    • if cataracts opaque (cloudy), may not see pupillary response with a penlight

    • be in front of person & make touch contact with the patient before beginning to speak

  • Hearing

    • decreased hearing

    • diminished sense of balance

    • speak slowly and distinctly; check for hearing aids; write notes if necessary


  • Taste & smell

    • altered (decreased sensitivity)

    • creates decreased appetite which causes poor nutritional condition

  • Touch

    • neuropathies cause decreased sensitivity to tactile senses

    • increased risk of injury without patient’s awareness (ie:burns from heating pads; sores on feet becoming infected)

  • Pain

    • lowered sensitivity - smaller amounts of pain medication are necessary


Communicating with the Geriatric Population

  • Make eye contact before speaking

  • Always identify yourself

  • Position yourself at the patient’s eye level

  • Locate hearing aid, eyeglasses, dentures

  • Turn on lights, turn off TV to minimize distractions

  • Use surname (Mr., Mrs., Ms.) until permission given to address patient otherwise

  • Be patient and gentle - give time for the patient to respond to your questions


Physiological Changes Affecting Mobility

  • Diminished vision

  • Loss of exercise tolerance

  • Diminished breathing capacity - become short of breath quicker and lose energy to complete tasks

  • Slowed psychomotor skills - losing independence

  • Decreased reflex time to prevent falls - more prone to injury


Mobility in Geriatrics

  • Bone loss affects mobility

    • Osteopenia - less than the normal amount of bone

    • Osteoporosis - bone mass so reduced that the skeleton loses its integrity and becomes unable to perform it’s supportive function

      • Loss of bone strength and size

      • Loss of flexibility

    • Vulnerable areas in women

      • spine, wrist, hip, collarbone, upper arm, leg, pelvis

    • Treatment - meds, weight bearing exercises like walking and lifting weights


Cardiovascular Changes in Geriatrics

  • Left ventricle thickens and enlarges (hypertrophy) decreasing compliance

  • Decreased responsiveness to catecholamine stimulation

  • Diminished ability to raise the heart rate in response to stress

  • Decreased function of SA & AV nodal cells increasing risk of dysrhythmias

  • Cardiac output decreased by 30%


  • Arteries become increasingly rigid

  • Increased blood pressure to pump through rigid blood vessels

  • Reduced blood flow to all organs

  • Decreased peripheral resistance

  • Widened pulse pressure - increasing systolic blood pressure

  • Heart muscle stiffens

  • Postural hypotension - vessels less reflexive and blood pressure drops when patient stands up too fast

  • Atherosclerosis - progressive, degenerative disease of medium and large sized arteries


Cardiovascular Disease

  • Risk factors for developing cardiovascular disease

    • Previous MI

    • Angina

    • Diabetes

    • Hypertension

    • High cholesterol level

    • Smoking

    • Sedentary lifestyle


Geriatrics and Acute Myocardial Infarctions

  • Elderly do not present with typical signs or symptoms of acute myocardial infarctions

  • Silent MI’s are marked by atypical complaints such as fatigue, nausea, abdominal pain and breathlessness

  • High index of suspicion for MI with unusual or absent warning signs/symptoms

  • Mortality doubles after age 70


Heart Failure

  • A clinical syndrome where the heart’s mechanical performance (pumping) is compromised and cardiac output cannot meet the body’s needs

  • Caused by: ischemia, valvular disease, dysrhythmias, hyperthryoidism, anemia, cardiomyopathy

  • In elderly, large incidence of non-cardiac causes

  • Generally divided into right and left heart failure

  • Ventricular output insufficient to meet the metabolic demands of the body


Heart Failure

  • Left ventricular failure

    • left ventricle fails as a forward pump

    • back pressure of blood in the pulmonary system leads to pulmonary edema

  • Right ventricular failure

    • right ventricle fails as a forward pump

    • back pressure of blood into the systemic venous circulation leads to venous congestion

  • Congestive heart failure

    • reduced stroke volume causes an overload of fluid in body tissues


Signs and Symptoms of Heart Failure

  • Dyspnea

  • Fatigue

  • Orthopnea - often sleeping on extra pillows to be more upright

  • Dry, hacking cough progressing to frothy sputum

  • Dependent edema due to right heart failure (check most dependent part of body depending on mobility - feet or sacral area)

  • Nocturia - urinating at nighttime

  • Anorexia, ascites (fluid in abdomen)


EMS Protocol Treatment Pulmonary Edema

  • Routine medical care

  • Oxygen via nonrebreather initially

    • BVM and intubation if needed

  • Stable patient with B/P >100 systolic

    • Nitroglycerin 0.4 mg sl (can repeat every 5 minutes to a maximum of 3 doses)

      • venodilator - reduces return of blood to heart to reduce workload of heart

    • Lasix 40 mg IVP (80 mg if on lasix)

      • diuretic and venodilator - reduces fluid return & workload on the heart


Pulmonary Edema cont’d

  • Stable patient cont’d

    • IfB/P >100 systolic, morphine 2 mg slow IVP

      • repeat 2mg every 3 mins as needed; max 10 mg

      • reduce anxiety; venodilator

  • Consider CPAP if B/P > 90

  • Unstable patient B/P <100 systolic

    • contact medical control

    • consider cardiogenic shock protocol

      • dopamine drip to raise blood pressure

      • fluid challenge would not be appropriate in patient with crackles/rales (wet lungs)

    • treat dysrhythmias as they present


Dysrhythmias and Geriatrics

  • Common dysrhythmias

    • PVC’s when over 80 years old

    • atrial fibrillation - increased risk for stroke

  • Morbidity/mortality

    • Serious due to decreased tolerance due to decreased cardiac output

    • The cerebral hypoperfusion leads to an increase in falls

    • Can lead to TIA’s and CHF (ineffective pumping)


Aneurysm

  • A bulge in a blood vessel; if large enough can put pressure on surrounding structures

  • May be aortic or cerebral

  • Associated risk factors

    • Smoking

    • Hypertension

    • Diabetes

    • Atherosclerosis

    • Hyperlipidemia

    • Polycythemia

    • Heart disease


Hypertension

  • Blood pressure ranges

    • optimal <120/<80

    • normal range <135/<85

    • hypertensive range >140/>90

  • Risk factors for developing hypertension

    • African Americans

    • elderly

    • geographics (Southeastern United States)

    • males (after menopause, women equally vulnerable)

    • socioeconomic status - lower the status the greater the risk


Hypertension

  • Morbidity/mortality

    • B/P greater than 160/95 doubles mortality in men

    • If blood pressure remains uncontrolled, damage seen to circulation (vascular system) and organs

      • cardiovascular disease (CVD) - stroke, MI, heart failure

      • end-stage renal disease


Hypertension

  • Awareness of the disease, it’s treatment, and control have improved but are still suboptimal

  • Prevention and control

    • Regular physical check ups

    • Follow medication routine if prescribed

    • Weight control

    • Exercise

    • Decreasing salt intake

    • Socially/emotionally active

    • Smoking cessation

    • Decreasing alcohol consumption


Hypertensive Emergencies

  • Definition

    • acute elevation of systolic blood pressure >230/>120

  • Signs & symptoms

    • epistaxis (nosebleed)

    • headache

    • visual disturbances

    • neurological changes - altered mental status and seizures

    • nausea & vomiting


SOP Treatment Hypertensive Emergencies

  • Routine medical care: IV-O2-monitor

  • Blood pressure in both arms and record

    • keep arm level with the heart

  • Vital signs and neuro status every 5 minutes

    • P-R-B/P-mental status-pupillary response-GCS

  • Lasix 40 mg IVP (80mg if on Lasix at home) - diuretic & vasodilator

  • If Medical Control orders, give NTG sl- vasodilator


Stroke - Cerebrovascular Accident

  • 3rd leading cause of death in the USA

  • Occlusive stroke - 80% incidence

    • causes brain ischemia

    • time to hospital treatment (TPA - fibrinolytic clot bluster) must be <3 hours from time of onset

    • most important question - “what time did the symptoms start?”

  • Hemorrhagic stroke - 20% incidence

    • higher percentage of death


Risk Factors For Stroke

  • Elderly

  • Atherosclerosis

  • Hypertension

  • Immobility

  • Limb paralysis

  • Congestive heart failure

  • Atrial fibrillation

  • Diabetes

  • Obesity


Signs and Symptoms of Stroke

  • Elevated blood pressure

  • Altered mental status or mood

  • Coma

  • Paralysis or extremity weakness

  • Slurred speech

  • Seizures

    Note: Suspect stroke in any elderly person with a sudden change in mental status. Always check blood sugar level in setting of altered mental status


Cincinnati Stroke Scale Assessment

  • Facial droop - have patient smile big enough to show their teeth

  • Arm drift - patient closes their eyes and extends arms out straight, palms facing up for 10 seconds

  • Abnormal speech - have the patient repeat back a response given (speech may have already been detected during normal conversation)


Documentation of Cincinnati Stroke Scale Results

  • Facial droop

    • right, left, or no droop present

  • Arm drift

    • right, left, or no arm drift

  • Abnormal speech

    • slurred speech or clear speech

  • Even normal responses with no deficits must be documented to show the assessment was performed


Endrocrine Emergencies in Geriatrics

  • Diabetes and Thyroid Disease

    • Due to the aging process and multiple disease processes the signs and symptoms may not appear to be classic

    • Suspect thyroid disease in an elderly patient who has vague symptoms of “illness”

  • 20% of the elderly have diabetes

  • 40% have impaired glucose tolerance

  • Type II (non-insulin dependent) is the most common form of diabetes and related to obesity


Hyperthyroidism

Weight loss

Mentation changes - nervousness, irritability

Tachydysrhythmias, palpitations

Hyperactivity, nervousness, irritability

Heat intolerance

Abdominal pain

Diarrhea

Weak leg muscles

perspirations

Hypothyroidism

Low metabolic state

 appetite with weight gain

Vague musculoskeletal complaints

Lethargy, fatigue, sluggishness

Cold intolerance

Constipation

Anemia

Depression, forgetfulness

Hyponatremia ( Na)

Moon face

Endocrine Disorders


Endocrine Complications

  • Hyperthyroidism

    • impaired glucose tolerance - problems with sugar processing (“pre-diabetic” condition)

    • type II diabetes

    • tachycardia

    • atrial fibrillation

  • Hypothyroidism

    • bradycardia


Integumentary (skin) Emergencies

  • Risk factors

    • Epidermal cellular turnover decreases

    • Slower wound healing

    • Increased risk for secondary infection

    • Increased risk of skin tumors, fungal or viral infections

    • Hair becomes finer and thinner


Pressure Ulcers

  • Results from hypoxia to tissue cells

  • Usually over bony areas

  • Common in immobile patients

    • those confined to bed or wheelchairs

  • Increased incidence in patients with:

    • altered sensory perception

    • skin exposure to moisture, especially prolonged

    • decreased activity & inability to shift positions

    • poor nutrition

    • friction or shear (ie: being pulled and dragged across a surface instead of being lifted)


Prevention of Pressure Ulcers

  • Immobile patients turned every 2 hours

  • Adequate hydration and nutrition provided

  • Personal hygiene maintained

  • Environment kept clean

  • Insure immobile patients do not have wrinkled bedsheets or clothes

  • Prescribed antibiotics or medications provided as ordered


Traumatic Deaths in Geriatrics

  • Trauma is the fifth leading cause of death

  • Mortality rates markedly increased in the elderly

  • One-third of traumatic deaths are in 65 - 74 year olds secondary to vehicular trauma

  • 25% result from falls

  • 50% of persons >80 years old die from falls

  • Post-injury disability more common in the elderly


Risk Factors Related to Trauma

  • Osteoporosis and muscle weakness increases the risk of fractures

    • women more vulnerable after menopause

    • men are also at risk for this disease

  • Reduced cardiac reserve decreases ability to compensate for blood loss

  • Decreased respiratory function increases risk for adult respiratory distress syndrome (ARDS)

  • Impaired renal function decreases ability to adapt to fluid shifts

  • Unsteady gait increases risks of falls


Traumatic Emergencies

  • Orthopedic Injuries

    • Pelvic fractures are highly lethal due to severe hemorrhage and associated soft tissue injury

    • Decreased pain perception may mask major fracture

    • A large percentage of elderly will die within one year of a hip fracture


Orthopedic Injuries

  • Hip fractures most common acute injury

  • Elderly are susceptible to stress fractures of femur, pelvis, tibia

  • Packaging should include adding bulk and padding between the patient and the back board

  • Kyphosis (rounding of the back) may require extra padding under shoulders to maintain alignment

    • often caused by osteoporosis, arthritis, vertebral slippage

  • Try to remove backboards as soon as possible & document removal


External Rotation


Fracture site


Fracturerepaired with plate & screws


Orthopedic Injuries From Falls

  • Major cause of morbidity/mortality

  • 10,000 deaths each year

  • One third of elderly fall at home each year

    • 1 in 40 are hospitalized

    • Cause significant mobility problems and functional dependence

  • Evaluate home for safe conditions

    • use of non-skid rugs

    • adequate lighting - hallways and at night

    • sturdy hand rails on stairs and in bathrooms

    • items within reach (ie: kitchen)

    • environment clear of clutter


Traumatic Head Injuries

  • Poorer outcome when injury associated with loss of consciousness

  • Brain shrinkage as one ages allows more space and greater brain movement

  • Increased incidence of subdural hematoma

    •  frequency of falls lead to more head injuries

    • brain shrinkage allows for more room to bleed

    • bleeding is venous - slow development of symptoms

      • headache

      • mental status changes


Spinal Column Injuries

  • Progressive arthritic and degenerative changes and osteoporosis associated with the aging process lead to higher incidence of bony injuries

  • Injuries have a negative impact on the function and quality of life

  • Pain  ability to perform activities of daily living

  • A psychosocial impact and threat to loss of independence


Compression Fractures of Spine

  • Occurs in 25% of post-menopausal women in the USA (up to 40% in women over 80)

  • Applied force may be minimal (lifting an object, stepping out of tub, sneezing) or more significant (major fall, MVC)

  • Acute onset low back pain, tenderness to palpation usually over T 8-12 and L 1-4

  • Rarely neurological symptoms

  • Transported in position of most comfort

  • Treatment symptomatic & conservative - rest, pain control, physical therapy


Burns in the Elderly

  • 1000 die each year from home fires

  • People over 60 have higher mortality rate from burns

  • Increased morbidity/mortality due to preexisting disease, skin changes (thinning & slower healing time), altered nutrition, increased risk to

    infection, decreased reaction time to

    move away from source


Treatment of Burn Injuries

  • Fluid important to prevent renal tubular damage from altered blood flow through the kidneys

  • Normal aging changes cause a decreased response in heart rate and stroke volume to hypovolemia

  • Hydration assessed in initial hours after burn injury by B/P, pulse, and urine output (1-2 ml/kg/hour minimally)

  • Rapid IV administration of fluid may cause volume overload (monitor lung sounds and vital signs frequently)


Toxicology & Geriatrics

  • Alterations in body composition, drug distribution, metabolism and excretion increases the risk for toxicity in elderly when exposed to over-the-counter medications, prescription medications, and other substances


Risk Factors Related To Toxicology

  • Decreased kidney function alters elimination

  • Increased likelihood of CNS side effects

  • Altered GI absorption

  • Decreased liver blood flow alters metabolism and excretion

  • History of alcoholism

  • Vision and memory changes result in noncompliance

  • Poor dexterity and eyesight decreases ability to choose correct medication and/or dosage


Prevention

  • Label medications clearly and in larger print

  • Provide assistance with nutrition and medication administration as needed

  • Consult with physician frequently

  • Make sure all physicians are aware of all medications taken

    • over-the-counter; prescription; herbal remedies

  • Limit OTC drug administration

  • Segregate storage in medicine cabinet

    • ingested medications on one shelf

    • topical medications on a different shelf


Elder Abuse

  • May occur in home or institutional setting

  • EMS & RN’s are mandated by State of Illinois to report suspicions to hot line

  • Abuse

    • any physical injury, sexual abuse or mental injury inflicted on a person, aged 60 or older, other than by accidental means

  • Neglect

    • failure to provide adequate medical or personal care or maintenance in which failure results in physical or mental injury or deterioration of condition


Elder Abuse Reporting

  • Document objectively and describe injuries using measurements and colors and not vague terms

  • Suspicions reported to ED staff by EMS

  • Abuse Hot Line

    • M-F 0830 - 1700: 1-800-252-8966

    • All other times: 1-800-279-0400


Medications for Home Use

  • Antidepressants

    • depression is a chronic illness of feeling hopeless and of losing interest

    • SSRI (selective serotonin reuptake inhibitors)

      • improves mood

      • lexapro, prozac, paxil, zoloft

    • Tricyclic antidepressants

      • amitriptyline, nortriptyline

    • MAO inhibitors

      • could have potentially life-threatening drug & food interactions

      • nardil, parnate


Medications for Home Use

  • Antianxiety

    • to relieve anxiety

    • benzodiazepines most common category

  • Anticoagulants

    • to inhibit the ability to clot; does not dissolve an existing clot

    • coumadin, lovenox, heparin, plavix, aspirin


Medications for Home Use

  • Lipid management

    • to reduce cholesterol and LDL levels which when elevated increases risks of coronary heart disease (CHD)

    • statins: lipitor, lescol, zocor, pravachol, mevacor, baycol, crestor, pitava

    • non-statin: zetia, niacin, velchol, torcetrapib, panavir


Medications for Home Use

  • ACE inhibitors

    • allow blood vessels to enlarge or dilate to decrease B/P

    • used to control B/P, treat heart failure, prevent kidney damage in hypertensive & diabetic patients

    • catopril (capoten), lotensin, vasotec, lisinopril (prinivil & zestril), monopril, ramipril (altace), aceon, accupril, univasc, mavik


Medications for Home Use

  • Beta blockers

    • relieves stress on heart by blocking some involuntary nervous system control on the heart

    • slows heart rate, decreases force of contractions, reduces blood vessels contractions

    • used to treat cardiac dysrhythmias, atrial fibrillation, hypertension, angina, post-MI (reduces morbidity), glaucoma, migraines, anxiety

    • most generic names end in “olol”

    • atenolol (tenormin), metoprolol (lopressor), propranolol (inderal), nadolol (corgard), carvedilol (coreg)


Medications for Home Use

  • Calcium channel blockers

    • block entry of calcium into muscle cells of heart and arteries to decrease the strength and rate of heart contractions and dilate arteries

    • used to treat high blood pressure, arrhythmia (atrial fibrillation), angina, used post-MI

    • verapamil (calan, isoptin), diltiazem (cardizem), nifedipine (procardia), bepridil (vascor), amlodipine (norvasc)


Medications for Home Use

  • Diuretics

    • to reduce the vascular fluid volume

    • used to treat heart failure, hypertension, fluid retention

    • aldactone, aldactazide, bumex, diuril, hydrochlorothiazide, HCTZ, hydrodiuril, dyazide, dyrenium, lasix (furosemide)

  • Diabetes

    • inadequate insulin activity for glucose metabolism

    • actos, amaryl, avandia, diabeta, glucophage, glucotrol, prandin, precose, starlix


Medications for Home Use

  • GI system

    • to treat acid reflux, excess acid, GERD, irritable bowel

    • aciphex, asacol, mylanta, pepcid, prevacid, prilosec, propulsid, reglan, rolaids, tagamet, tums, zantac, lomotil, bentyl, imodium


Medications for Home Use

  • Insomnia and sleep disorders

    • sleep deprivation affects the body’s metabolism

    • insomniacs are at increased risk for host of diseases; decreases motor skill and affects memory and mental performance

    • being awake 24 hours is equivalent to a blood alcohol level of 0.1

    • ambien, halcion, restoril, lunesta benzodiazepines like lorazepam (ativan), diazepam (valium)


Medications for Home Use

  • Erectile dysfunction

    • to improve erectile function (impotence) in men and sexual arousal in women

    • increases amount of blood flow, does not automatically produce an erection but allows one after physical and psychological stimulation

    • not to be taken if MI, stroke or life-threatening dysrhythmia in last 6 months

    • not to be mixed with nitrate use (NTG) in same 24 hours period -blood vessel dilation could be too much to reverse & could cause death

    • viagra (sildenafil), cialis, levitra


Pearls of Medication

  • Benzodiazepines

    • when mixed with alcohol increases depressant effects - watch for respiratory depression

  • Anticoagulants

    • increases risk for bleeding complications

  • Beta blockers

    • patient won’t respond with tachycardia even in shock due to effects of drugs

  • Hypertensive patient

    • a normal reading (ie: 100/70) may be shock for the patient with a chronically elevated blood pressure


References

  • Bledsoe, B. E., Porter, R. S., Cherry, R. A. Paramedic Care Principles & Practices. Brady 2006.

  • www.aafp.org

  • www.allaboutvision.com

  • www.americanheart.org

  • www.aoa.org/documents/CPG-8.pdf

  • www.clara.abbott.com

  • www.dynomed.com/encyclopedia/encyclopedia/spine/ Compression_Fracture.htm

  • www.glaucoma.org

  • www.nihseniorhealth.gov

  • www.nlm.nih.gov/medlineplus/cataract.html

  • www.pads-crisis-services.net

  • www.richmondeyecare.com/vets2html


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