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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 patients geriatric population medications for home use

ECRN Packet:Culturally Diverse PatientsGeriatric PopulationMedications for Home Use

Condell Medical Center EMS System


Site Code #10-7214-E-1206

Revised by Sharon Hopkins, RN, BSN

EMS Educator


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
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 patients4
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 patients5
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
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
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 patients8
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 patients9
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
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
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
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
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
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
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 challenged16
Culturally Diverse Patients - Financially Challenged
  • Signs of impairment
    • homelessness
    • chronic illness with frequent hospitalizations
    • poor personal hygiene
    • self-employment
resources for referral
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 referral18
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
challenges in the geriatric population
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
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 the geriatric population22
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
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
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
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
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
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
Cardiovascular Disease
  • Risk factors for developing cardiovascular disease
      • Previous MI
      • Angina
      • Diabetes
      • Hypertension
      • High cholesterol level
      • Smoking
      • Sedentary lifestyle
geriatrics and acute myocardial infarctions
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
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 failure33
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
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
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
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
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)
  • 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
  • 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
  • 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
  • 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
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
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
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
Risk Factors For Stroke
  • Elderly
  • Atherosclerosis
  • Hypertension
  • Immobility
  • Limb paralysis
  • Congestive heart failure
  • Atrial fibrillation
  • Diabetes
  • Obesity
signs and symptoms of stroke
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
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
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
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
endocrine disorders

Weight loss

Mentation changes - nervousness, irritability

Tachydysrhythmias, palpitations

Hyperactivity, nervousness, irritability

Heat intolerance

Abdominal pain


Weak leg muscles



Low metabolic state

 appetite with weight gain

Vague musculoskeletal complaints

Lethargy, fatigue, sluggishness

Cold intolerance



Depression, forgetfulness

Hyponatremia ( Na)

Moon face

Endocrine Disorders
endocrine complications
Endocrine Complications
  • Hyperthyroidism
    • impaired glucose tolerance - problems with sugar processing (“pre-diabetic” condition)
    • type II diabetes
    • tachycardia
    • atrial fibrillation
  • Hypothyroidism
    • bradycardia
integumentary skin emergencies
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
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
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
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
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
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
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
orthopedic injuries from falls
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
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
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
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
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
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
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
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
  • 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
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
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
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 use74
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 use75
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 use76
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 use77
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 use78
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 use79
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 use80
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 use81
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 use82
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
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
  • Bledsoe, B. E., Porter, R. S., Cherry, R. A. Paramedic Care Principles & Practices. Brady 2006.
  • Compression_Fracture.htm