CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 13 General Pharmacology

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Copyright 2004 Prentice Hall PublishingA division of Pearson Inc.

Prehospital Emergency Care 7eMistovich/Hafen/Karren

Chapter 13Chapter 13General Pharmacology

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• Administering Medications• Medications Commonly Administered by the

EMT-Basic• Medication Names• Routes of Administration• Medication Forms

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• Essential Medication Information• Key Steps in Administering Medications• Reassessment Following Administration• Sources of Medication Information

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• As an EMT-Basic, there will be situations in which you administer, or help in the administration of, certain medications to the patient.

• You must be certain that you are correct regarding the decision to administer a medication. Once it is administered, you cannot extract it again from the body.

IntroductionIntroduction1313

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• The EMT-B must take the responsibility to administer drugs seriously.

• It is your responsibility to be completely familiar with the medications you will be handling during patient care as an EMT-Basic.

• Additionally, there are certain terms you should be familiar with.

1313Administering MedicationsAdministering Medications

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• Pharmacology– This refers to the general study of the interactions

between a drug and the body.

• Medication– Is generally defined as a substance used as a

remedy for an illness.

• Drug– A chemical substance used to prevent or treat an

illness.– Generally, the term “medication” and “drug” are

used interchangeably.


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• Medications have physiological effects that, when appropriately administered, may improve the patient’s condition.

• As an EMT-B, you will administer medications under the license of your Medical Director.

• You are only allowed to administer medications that are permitted by your Medical Director.


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• There are three medications you carry on the ambulance with you:– Oxygen, activated charcoal, oral glucose, aspirin

• There are an additional three medications which you are allowed to assist in the administration of, providing the patient is prescribed one of these drugs:– Nitro, epinephrine, metered-dose inhaler

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Medications Prescribed Medications Prescribed for the Patientfor the Patient

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• Medications can have up to four names.• Since they are used interchangeably, the EMT-

B should be familiar with them.– Chemical Name: name describing chemical structure– Generic Name: nonproprietary name, similar to

chemical name– Trade Name: brand name, for marketing purposes– Official Name: official name, followed by U.S.P. or

N.F.

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• Chemical Name:– 1,2,3-propanetriol trinitrate

• Generic Name:– Nitroglycerin tablets

• Trade Name:– Nitrostat®

• Official Name:– Nitroglycerin tablets, U.S.P.

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• The route of the medication refers to how the patient is to take it, or the EMT-B to administer it.

• The route chosen also influences the rate in which it is absorbed in the body, and thus, helps define the length of time needed for a change in the body to be observed clinically.

1313Routes of AdministrationRoutes of Administration

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• Sublingual– The mucous membranes beneath the tongue are

highly vascular, and can absorb medication readily.

– Naturally, the patient must be alert for you to use this route; otherwise they may aspirate the medication.

– When using this route, remind the patient not to chew or swallow the medication.


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• Oral– This route allows the medication to be absorbed

across the membranes of the stomach and/or the intestinal tract.

– The patient must also be alert for the EMT-B to use this route so that the patient will swallow the medication rather than aspirating it should their orientation be diminished.


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• Inhalation– The medication for this route is prepared as a gas

or aerosol so that the patient can inhale it.– Upon inhalation, the medication is absorbed

across the respiratory tract.– The key when using this route is assuring the

patient has an adequate tidal volume so that they inhale the medication deep into the pulmonary tree.


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• Injection– Refers to the deposition of the medication into the

tissues, and for the EMT-B, this means specifically into the muscle mass.

– The specific route is also known as intramuscular.– Since a needle is employed to inject the medication,

the EMT-B must exercise extreme caution.– Only specific muscle groups are used by the EMT-B.


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• Medications come in several different forms.• The form usually limits the administration to

one specific route.• The form also helps define whether the drug

has a local effect, or systemic effect.• Common forms include:

– Tablets, liquid, gels, suspensions, fine powder for inhalation, gases, sprays, and nebulized liquids

1313Medication FormsMedication Forms

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• Compressed powder or tablet– A compressed powder that

is formed into a small disk

or elongated shape.– Nitroglycerin and aspirin

tablets are good examples

of this type.


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• Liquid for injection– A liquid substance with no particulate

(undissolved) matter.– Epinephrine for intramuscular injection is an

example.


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• Gel– A viscous substance that the patient could swallow

so that the mucous membranes of the GI tract could absorb it


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• Suspension– Undissolved drug particles

that are mixed in a liquid base.– Since the medication does

not dissolve, you must thoroughly mix it prior to administration.

– Activated charcoal is prepared in this fashion.


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• Fine powder for inhalation– A crystalline form of the medication that is mixed

with a liquid to form a suspension.– Must also be shaken prior

to administration.– Medication gets absorbed

across the pulmonary tract.– Medications for common

breathing diseases are packaged this way.


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• Gas– A non-liquid, non-particulate medication that is

inhaled and readily absorbed across the

pulmonary tract (alveoli).– Oxygen is the medication

most commonly used by

the EMT-B in this form.


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• Spray– A liquid medication can be

deposited (or sprayed) under

the tongue for absorption.– This is another common form

that the drug nitroglycerin

may come in.


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• Liquid/Vaporized fixed-dose inhaler– A nebulizer is a device that uses compressed gas,

usually oxygen, that is forced into a small chamber containing the liquid drug.

– As the gas mixes with the liquid and exits the chamber, it vaporizes the medication to allow the patient to then inhale it.

– This allows deposition of the drug directly on the mucous membranes of the pulmonary system, where it is intended to exert its action.


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• As stated earlier, the EMT-Basic must be intimately familiar with the drugs you will be administering.

• Knowing the following terms will allow you to better understand the drugs, and thus, use them appropriately.– Indications, Contraindications, Dose,

Administration, Actions, Side Effects

1313Essential Medication InformationEssential Medication Information

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• Indications– This defines what clinical setting the use of the

drug is intended for.– It is anticipated that the administration of the drug

will improve the patient’s clinical condition.– For example, the use of oxygen for a patient

complaining of respiratory distress.


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• Contraindications– This refers to specific clinical conditions in which

the drug was going to be used, but cannot due to some other coexisting problem.

– For example, it would be contraindicated to use nitroglycerin for cardiac chest pain, if the blood pressure was too low.

– A contraindication does not apply if the drug was never appropriate. For example, a contraindication for glucose is not chest pain, because glucose was never indicated in the first place.


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• Dose– The dose refers to the amount of drug to be

administered.– Adults and pediatrics may have two different

doses of the same drug.– The EMT-B should know, by memory, the dosages

for all the drugs which you may be responsible for administering.


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• Administration– This refers to the route in which the dose of the

indicated medicine is to be given.– The EMT-B will be using the inhalation, oral,

sublingual, and injection routes.– Many times the form of medication defines how it

will be administered. For example, oxygen is a gas which is given via inhalation.


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• Actions– These are the effects of the drug on the body.– Medications modify what certain cells or organs of

the body do, in order to correct or prevent some abnormality.

– Also known as the “mechanism of action.”– If the EMT-B understands this aspect of the

medication, all other aspects become very logical.


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• Side Effects– Some medications, despite their ability to correct

one abnormality, may cause a disturbance elsewhere in the body.

– The side effects generally are tolerated by the patient, and are predictable if you understand the drug’s actions.

– For example, nitroglycerin (a vasodilator) may cause a drop in the blood pressure as a side effect.


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• Obtain an order from Medical Direction.– All medications administered by the EMT-B are

done so only with permission of your Medical Director.

– This order may be provided via off-line standing orders, or on-line communication with the physician.

– ALWAYS be certain of the dose prior to administering it!

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Key Steps in Key Steps in Administering MedicationsAdministering Medications

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– Example of on-line medical direction for medication administration.

– Be sure to reverify the drug, dose, and route when speaking to the physician.

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• Select the proper medication.– The EMT-Basic’s responsibility next is to select

the appropriate medication for the clinical situation.

– If the medication belongs to the patient, and you are permitted to administer it (nitro, inhaler, or epi-pen), be certain the drug is prescribed to the patient.

– Knowing the various names (trade, generic, etc.) of the medications is extremely helpful here.

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• Verify the patient’s prescription.– When administering one of the permitted

medications not carried by the EMS unit, it must be obtained from the patient.

– You must CLEARLY assure the medication you are about to administer is prescribed to your patient specifically (you cannot “share” medications).

– Even if the patient already took a medication not prescribed to them, you cannot administer it.

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• Check the expiration date.– All medications, eventually, deteriorate to the

point they are ineffective.– Because of this, there will be an expiration date

printed on the drug packaging, or on the prescription label.

– Obviously, you cannot administer an expired medication.

– If expired, discard the medication in accordance with your state drug or pharmacy guidelines.

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• Check for discoloration or impurities.– Some medications may discolor, become

cloudy, or have visible particulate matter should they become contaminated.

– This may also happen if the medication has expired some time ago.

– In either instance, do not administer the medication. Rather, discard of it appropriately.

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• Verify the form, route, and dose.– Be certain the drug form is appropriate for the

route selected during administration.– Also verify that the prescribed dose of the drug

matches the medical direction given when administering that drug.

– Thoroughly inspect the drug information, do not rely on “similar packaging.” Drugs with similar packaging may still have different doses.

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• The “Five Rights”– The five rights will help you remember what to

determine prior to administering any drug:• Right patient• Right medication• Right route• Right dose• Right date

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• Documentation– Once administered, document the drug given

along with its dose, route, and time it was administered.

– Also necessary is

documentation of

the patient’s response

following administration

(or lack thereof).

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• Following administration of a medication, perform an ongoing assessment to note any changes.

• Also document the absence of any specific changes anticipated by the drug administration.– For example, if chest pain subsided with nitro,

document that. Also, if the chest pain did not change with nitro, that is also important to document.

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Reassessment Reassessment Following AdministrationFollowing Administration

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• Recommended reassessment parameters:– Mental status– Patency of the airway– Breathing rate and quality– Skin temp, color, and condition– Blood pressure and heart rate– Alterations in the complaint(s) of the patient– Medication side effects– General improvement or deterioration in the clinical

condition of the patient following drug administration

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Reassessment Reassessment Following AdministrationFollowing Administration

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• Where to find more information on drugs you administer, or that you commonly encounter prehospitally:

• American Hospital Formulary Service• AMA Drug Evaluation• Physicians’ Desk Reference (PDR)• Drug package inserts• Poison Control Centers (PCC)• EMS pocket drug reference guide• Epocrates for the Personal Digital Assistant (PDA)

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Sources of Sources of Medication InformationMedication Information

Documents

CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 13 General Pharmacology