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Essential Medication Terms and Dosage Conversions

Understand medication forms, names, terms, dose metrics, legal aspects, new drug development, patient care guidelines, and drugs' impact on body systems. Learn about drug profiles, administration rights, and pediatric/geriatric considerations. Gain insights into absorption rates and cellular communication in disease scenarios.

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Essential Medication Terms and Dosage Conversions

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  1. Chapter 16 General Pharmacology

  2. Drugs are chemicals used to diagnose, treat, and prevent disease.

  3. Medication Forms Used by the EMT-Basic • Compressed powders or tablets (e.g., nitroglycerin) • Liquids for injection (e.g., epinephrine) • Gels (e.g., glucose) • Suspensions (e.g., activated charcoal) • Fine powder for inhalation • Gases (e.g., oxygen) • Aerosol or spray (e.g., nitroglycerin)

  4. Names of Drugs • Chemical • States its chemical composition and molecular structure • Generic • Usually suggested by the manufacturer • Official • As listed in the U.S. Pharmacopeia • Brand • The trade or proprietary name

  5. Medication Names • Generic • Name listed in the U.S. Pharmacopoeia • Name assigned to drug before it becomes officially listed • Usually a simple form of the chemical name • Trade • Brand name manufacturer uses in marketing the drug

  6. Medication Terms • Indications • Most common uses of the drug • Contraindications • Situations in which a drug should not be used • May cause harm to the patient • May have no effect in improving the patient's condition

  7. Medication Terms • Dose • How much of the drug should be given • Administration • Route by which the medication is administered • Actions • Desired effects a drug has on the patient/body systems

  8. Medication Terms • Side effects • Actions of a drug other than those desired

  9. DoseMetric Conversions Kilograms Grams Milligrams Micrograms 1 kg 1000 g 1 g 1000 mg 1 mg 1000 g

  10. DoseMetric Conversions Liters Milliliters 1 L 1000 mL 0.5 L 500 mL 0.1 L 100 mL 0.01 L 10 mL 0.001 L 1 mL 1000 mL 1 L

  11. Legal • Knowing and obeying the laws and regulations governing medications and their administration is an important part of an EMT’s career. • These include federal, state, and agency regulations.

  12. Federal • Pure Food & Drug Act of 1906 • Harrison Narcotic Act of 1914 • Federal Food, Drug, & CosmeticAct of 1938 • Comprehensive Drug AbusePrevention & Control Act of 1970

  13. State vs. Local Standards • They vary widely. • Always consult local protocols and with medical direction for guidance in securing and distributing controlledsubstances.

  14. New Drug Development

  15. Name Generic, trade Classification Mechanism ofAction Indications Pharmacokinetics Side Effects/adverse reactions Routes ofAdministration Contraindications Dosage How Supplied SpecialConsiderations Components of a Drug Profile

  16. Providing Patient Care Using Medications • Have current medication referencesavailable. • Take careful drug histories including: • Name, strength, dose of prescribed medications • Over-the-counter drugs • Vitamins • Herbal medications • Allergies

  17. Providing Patient Care Using Medications • Evaluate the patient’s compliance, dosage, and adverse reactions. • Consult with medical direction as needed.

  18. Seven “Rights” of Medication Administration • Right medication • Right dosage • Right time • Right route • Right patient • Right documentation • Right to refuse

  19. De-Mystifying Pharmacology • Drugs do not do anything new. • They can only alter functions that are already occurring in the body. • Replace a function, enhance a function or interrupt a function • Drugs will always leave residual effects. • Even selective-site drugs! • Albuterol and muscle tremors

  20. De-mystifying Pharmacology • Drugs usually have to bind to something before anything can occur. • Antacids bind to receptors in the stomach • Morphine binds to euphoria receptors, nausea and vessel control receptors in the brain

  21. Pediatric Considerations • Dosages must be administered based on body weight. • Patient may have difficulty with inhalation. • Consider spacer or extension tubing • Patient may be reluctant to take medication. • Enlist patient/parent cooperation

  22. Geriatric Considerations • Patient may take several medications. • Prone to adverse effects, drug interactions, inadvertent overdose • When possible, transport all medications to hospital with patient. • May help hospital staff diagnose and manage patient condition

  23. Absorption Rates

  24. Reassessment Strategies • After drug administration, reassess patient for: • Therapeutic effects • Side effects • Noticeable changes in patient condition • Document time of administration • Document times of ongoing assessments • Vital signs • Changes in patient condition • Therapeutic or side effects

  25. Cells talk to each other • Three distinct languages • Nervous system • neurotransmitters • Endocrine system • hormones • Immune system • cytokines

  26. In disease, all systems are affected • The three systems can’t exist without each other • The actions of one impact the actions of the others • I.e., stress (nervous system) disrupts endocrine system which may respond with glucocorticoid production = suppressed immune response

  27. Drug Classifications • Drugs are classified 3 different ways: • By body system • By the action of the agents • By the drug’s mechanism of action

  28. Drug Class Examples • Nitroglycerin • Body system: “Cardiac drug” • Action of the agent: “Anti-anginal” • Mechanism of action: “Vasodilator” • Indications for nitroglycerin • Cardiac chest pain • Pulmonary edema • Hypertensive crisis • Which drug class best describes this drug?

  29. Medications Carried on the EMS UnitActivated Charcoal • Used for toxic ingestion • Binds to certain poisons • Prevents absorption • Not all brands are the same. • Some bind much more poison. • Consult medical direction about the brand to use

  30. Medications Carried on the EMS UnitOral Glucose • Used for altered mental status, suspected hypoglycemia • Absorbed in the oral mucosa • Provides needed glucose for patient with low blood sugar

  31. Medications Carried on the EMS UnitOxygen • Increases oxygen delivery to blood • Essential treatment for hypoxia and hypoperfusion • % of delivered oxygen (dose) determined by flow rates and delivery device

  32. Medications carried on the EMS unitEpinephrine • Used to treat severe allergic reaction • Blocks release of histamine • Increases vascular resistance to maintain blood pressure

  33. Epinephrine Absorption • What is the concentration and dosing time for subcutaneous and IV epinephrine? • SQ - 1:1000 with repeat doses every 3-5 minutes • Why is there a need for 2 different concentrations? • Epinephrine is a short-lived drug and will break down quickly • SQ absorption is significantly slower than IV • A higher concentration of the drug will assure that enough of the active drug will still be available after it is absorbed

  34. Medications carried on the EMS unitAspirin • Action • Produces analgesia • Reduces inflammation and fever by inhibiting the production of prostoglandins • Decreases platelet aggregation

  35. Aspirin • For cardiac chest pain • Usual dose • 81 mg x 3 or 4 (243 – 324 mg) po • chewable

  36. Men 50 y/o or more (no clinical evidence of coronary disease). ASA - Risk of MI 44% less No significant effect on risk of stroke and no effect on mortality from cardiovascular causes Women 65 y/o or more (no history of cardiovascular disease) ASA - No significant effect on risk of MI or risk of death from cardiovascular causes BUT 24% reduction in risk of ischemic stroke and 17% reduction in stroke risk overall New Info!New England Journal of Medicine, 3/05

  37. Drugs carried on the EMS unitActivated Charcoal • To treat poison ingestion • Acts externally to the surface of the bowel to adsorb toxins from the mucosa • Increases drug diffusion rate from plasma into GI tract for absorption

  38. Medications EMT-Basic May AssistPrescribed Inhalers • Used to treat bronchoconstriction • Prescribed by patient’s physician • Administration is approved by medical direction and/or by local protocol. • May be carried in the ambulance in some EMS systems

  39. Albuterol • Causes bronchodilation by acting on B-2 receptors (B-agonist) • Atrovent (Ipratroprium) • Causes bronchodilation by inhibiting acetylcholine at receptor sites on bronchial smooth muscle

  40. Medications EMT-Basic May AssistNitroglycerin • Used to treat ischemic chest pain • Dilates vessels to improve circulation through the coronary arteries • Decreases the workload of the heart by dilating peripheral vessels • Administered under the tongue by tablet or spray

  41. Nitroglycerin • How does the drug come packaged? • As a tablet, spray, ointment, liquid (IV) • Nitroglycerin forms and absorption rates • SL: 1-3 minutes • Ointment/transdermal: 30 minutes • IV: immediate!

  42. Summary • Medications play a critical role in EMS. • Care must be taken to assess patients to identify the need for medication. • Be familiar with the indications, contraindications, and side effects of administered medications. • Always contact medical direction and/or follow local protocols. • Remember the “rights” of medication administration.

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