Chapter 12 Principles of Pharmacology

Question 1

Pharmacology

Answer 1

the science of drugs, including their ingredients, preparation, uses, and actions on the body

Question 2

Medication

Answer 2

a substance used to treat or prevent disease or relieve pain

Question 3

Pharmacodynamics

Answer 3

the process by which medication works on the body

Question 4

Agonist

Answer 4

medication that causes stimulation of receptors

Question 5

Antagonist

Answer 5

medication that binds to a receptor and blocks other medications or chemicals from attaching there

Question 6

Dose

Answer 6

the amount of the medication that is given, which depends on:
a. Patient’s weight
b. Patient’s age
c. Desired action of the medication

Question 7

Action

Answer 7

the therapeutic effect that a medication is expected to have on the body

Question 8

Pharmacokinetics

Answer 8

actions of the body upon the medication (or chemical)
a. Onset of action: time from medication administration until clinical effects occur
b. Duration: length of time that clinical effects persist
c. Elimination: how medications or chemicals are removed from the body
d. Peak: the point or period when the maximum clinical effect is achieved

Question 9

Factors affecting how a medication works

Answer 9

a. Route of administration
b. Shock states

Question 10

Indications

Answer 10

reasons or conditions for which a particular medication is given

Question 11

Contraindications

Answer 11

when a medication would either harm the patient or have no positive effect

a. Absolute contraindications: when the medication should never be given
b. Relative contraindications: when the benefits of administering the drug may outweigh the risks

Question 12

Adverse effects

Answer 12

any actions of a medication other than the desired ones
a. Unintended effects: effects that are undesirable but pose little risk to the patient
b. Untoward effects: effects that can be harmful to the patient

Question 13

Generic name

Answer 13

The generic name is a simple, clear, nonproprietary name.
a. Generic names are not capitalized.

Question 14

Trade name

Answer 14

The trade name is the brand name that a manufacturer gives to a drug.
a. Trade names begin with a capital letter.
b. One drug may have more than one trade name.

Question 15

Prescription drugs

Answer 15

are distributed only by pharmacists and require a physician’s order.

Question 16

Over-the-counter (OTC)

Answer 16

drugs may be purchased directly without a prescription.

Question 17

Other kinds of drugs

Answer 17

Recreational drugs (eg, heroin, cocaine)
b. Herbal remedies
c. Enhancement drugs
d. Vitamin supplements
e. Alternative medicines

Question 18

why ask patients about any and all medications or drugs they are taking?

Answer 18

Any medication that a patient takes can be pharmacologically active and can cause an effect

Question 19

Enteral medications

Answer 19

enter the body through the digestive system.
a. Often in pill or liquid form, such as cough medicine
b. Medications administered via this route tend to be absorbed slowly and are not commonly used in an emergency setting.

Question 20

Parenteral medications

Answer 20

enter the body by some other means.
a. Often in liquid form administered through needles or syringes
b. Absorbed more quickly and offer a more predictable and measurable response
3. Absorption: the process by which medications travel through body tissues to the bloodstream

Question 21

Per rectum (PR)

Answer 21

i. “By rectum”
ii. Easy to administer; provides reliable absorption

Question 22

Oral (PO)

Answer 22

i. “By mouth”
ii. Enters the bloodstream through the digestive system
iii. Takes as long as 1 hour for absorption to occur

Question 23

Intravenous (IV) injection

Answer 23

i. “Into the vein”
ii. Fastest delivery, but cannot be used for all medications

Question 24

Intraosseous (IO) injection

Answer 24

i. “Into the bone”
ii. Reaches the bloodstream through the bone marrow
iii. Requires drilling a needle into the outer layer of bone

Question 25

Subcutaneous (SC) injection

Answer 25

i. “Beneath the skin”
ii. Injection given into the fatty tissue between the skin and muscle

Question 26

Intramuscular (IM) injection

Answer 26

i. “Into the muscle”
ii. Usually absorbed quickly
iii. Not all medications can be administered by the IM route.

Question 27

Inhalation

Answer 27

i. Breathed into the lungs
ii. Absorbed into the bloodstream quickly
iii. Forms include aerosols, fine powders, and sprays

Question 28

Sublingual (SL)

Answer 28

i. “Under the tongue”
ii. Enters through the oral mucosa under the tongue and is absorbed into the bloodstream within minutes

Question 29

Transcutaneous (transdermal)

Answer 29

i. “Through the skin”
ii. Applied as a patch to the skin
iii. Longer-lasting effect than other routes

Question 30

Intranasal (IN)

Answer 30

i. Relatively new format for the delivery of medication
ii. The medication is pushed through a device called a mucosal atomizer device (MAD) that aerosolizes the liquid for delivery into the nostril.
iii. Quick absorption

Question 31

Common routes of administration (list 10)

Answer 31

1. Per rectum (PR) – By rectum
2. Oral (PO) – By Mouth
3. Intravenous (IV) injection – Into the vein
4. Intraosseous (IO) injection – Into the bone
5. Subcutaneous (SC) injection – Beneath the skin
6. Intramuscular (IM) injection – Into the muscle
7. Inhalation – Breathed into the lungs
8. Sublingual (SL) – Under the tongue
9. Transcutaneous (transdermal) – Through the skin
10. Intranasal (IN) – into the nostril

Question 32

Suspension

Answer 32

a mixture of finely ground particles that are distributed evenly throughout a liquid by shaking or stirring but do not dissolve
a. Suspensions separate if they stand or are filtered.
b. It is important to shake or swirl a suspension before its administration.

Question 33

Metered-dose inhalers (MDIs)

Answer 33

1. Liquids or solids that are broken into small enough droplets or particles may be inhaled.
2. A spray canister directs such substances through the mouth and into the lungs.
3. Delivers the same amount of medication each time it is used
4. Often used for respiratory illnesses such as asthma or emphysema

Question 34

Transcutaneous medications

Answer 34

Also referred to as transdermal medications
2 Absorbed through the skin
3. Many transdermal medications have systemic (whole-body) effects
4. If you touch the medication with your skin, you will absorb it just like the patient.

Question 35

Gels

Answer 35

1. Semiliquid
2. Administered in capsules or through plastic tubes

Question 36

Gases for inhalation

Answer 36

1. Usually delivered through a nonrebreathing mask or nasal cannula
2. Oxygen is the medication most commonly used in gas form outside the operating room.

Question 37

Follow the “rights” of medication administration. (list 9)

Answer 37

1. Right patient
2. Right medication
3. Right dose
4. Right time
5. Right route
6. Right education
7. Right to refuse
8. Right response and evaluation
9. Right documentation

Question 38

Peer-assisted medication

Answer 38

a. You administer medication to yourself or your partner.
b. Example: You were exposed to a toxic agent.

Question 39

Patient-assisted medication

Answer 39

a. You assist the patient with administering his or her own medication.
b. Examples: epinephrine auto-injector, nitroglycerin, metered-dose inhaler

Question 40

EMT-administered medication

Answer 40

a. The EMT directly administers the medication to the patient.
b. The patient may be severely confused or unable to understand the need for the medication.
c. Examples: oxygen, oral glucose, aspirin

Question 41

steps to perform oral medications

Answer 41

a. Take standard precautions.
b. Confirm the medication is not expired.
c. Obtain medical direction per local protocol.
d. Confirm that the patient has a patent airway and is able to swallow or chew the medication.
e. Monitor the patient’s condition and document.

Question 42

Oral glucose

Answer 42

a. Glucose is a sugar that cells use for energy; it is necessary for brain cells.
b. Hypoglycemia: extremely low blood glucose
c. Oral glucose can counteract the effects of hypoglycemia.
d. An EMT can give glucose only by mouth in the form of a gel.
e. Never administer oral medications to an unconscious patient or to one who is unable to swallow or protect the airway.

Question 43

Aspirin

Answer 43

a. Reduces fever, pain, and inflammation
b. Inhibits platelet aggregation (clumping), which is useful during a potential heart attack
c. Contraindications
i. Hypersensitivity to aspirin
ii. Preexisting liver damage, bleeding disorders, and asthma
iii. Should not be given to children

Question 44

Sublingual medications - Considerations

Answer 44

a. Advantages
i. Easy to talk with awake and alert patients and advise them to place a pill under their tongue
ii. Absorption is relatively quick.
b. Disadvantages
i. Any medication placed in the mouth requires constant evaluation of the airway.
ii. Should not be used if the patient is uncooperative or unconscious

Question 45

Nitroglycerin

Answer 45

Nitroglycerin extended-release capsules are used to prevent chest pain (angina) in people with a certain heart condition (coronary artery disease). This medication belongs to a class of drugs known as nitrates. Angina occurs when the heart muscle is not getting enough blood. This drug works by relaxing and widening blood vessels so blood can flow more easily to the heart.This medication will not relieve chest pain once it occurs. It is also not intended to be taken just before physical activities (such as exercise, sexual activity) to prevent chest pain. Other medications may be needed in these situations. Consult your doctor for more details.

How to use Nitroglycerin
Take this medication by mouth as directed by your doctor, usually 3 to 4 times daily. It is important to take the drug at the same times each day. Do not change the dosing times unless directed by your doctor. The dosage is based on your medical condition and response to treatment.

Swallow this medication whole. Do not crush or chew the capsules. Doing so can release all of the drug at once and may increase your risk of side effects.

Use this medication regularly to get the most benefit from it. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

Question 46

Intramuscular medications - Considerations

Answer 46

a. Advantages
i. Provides quick and easy access to the circulatory system without the need for placing a needle within a vein
ii. Blood flow to the muscles is relatively stable even during circumstances of severe illness or injury.
b. Disadvantages
i. Use of a needle and subsequent pain

Question 47

Epinephrine (adrenaline)

Answer 47

a. Also known as adrenaline
b. Released inside the body when there is sudden stress
c. Main hormone that controls the body’s fight-or-flight response
d. Characteristics
i. Secreted naturally by the adrenal glands
ii. Dilates passages in the lungs
iii. Constricts blood vessels, causing increased blood pressure
iv. Increases heart rate and blood pressure
e. Should be given only to patients who are experiencing a life-threatening allergic reaction
i. Epinephrine may be dispensed from an auto-injector.
ii. Automatically delivers a preset amount of the medication (usually 0.3 mg)
iii. Some services do not permit EMTs to carry epinephrine but do allow them to assist patients in administering their own epinephrine.

Question 48

What is Naloxone used for

Answer 48

Used to reverse the effects of an opioid overdose

Question 49

Intranasal medications - Naloxone

Answer 49

a. Most common technique for naloxone administration
b. The same considerations described for administering injectable naloxone apply here.
c. If naloxone is not available, bag-mask ventilations may be required.

Question 50

Oxygen

Answer 50

a. By far the most commonly administered medication in the prehospital setting
b. All cells, especially those in the heart and brain, need oxygen to function properly.
c. Generally administered:
i. Via a nonrebreathing mask at 10 to 15 L/min
ii. Via nasal cannula at 2 to 6 L/min
d. Must also provide artificial ventilations if the patient is not breathing (using a bag-mask device at 15 L/min)
e. Ensure that there are no open flames, lit cigarettes, or sparks in the area in which you are administering oxygen.

Question 51

Metered-dose inhalers and nebulizers

Answer 51

Used to administer liquid medications that have been turned into a fine mist by a flow of air or oxygen
b. Medication is atomized, breathed into the lungs, and delivered to the alveoli.
c. Advantages
i. Fast and relatively easy route to access
d. Disadvantages
i. Patient needs to be cooperative and control breathing
ii. Cannot be used for unconscious patients

Question 52

Medications administered using an MDI or small volume nebulizer

Answer 52

a. An MDI requires a great deal of coordination to administer.
i. May be difficult to achieve when a person is having trouble breathing
b. Use a spacer (adapter) to avoid spray misdirection.
c. SVNs are much easier to use than MDIs.
i. Takes longer to deliver the medication
ii. Requires an external air or oxygen source
iii. Can be more effective than an MDI in moderate to severe respiratory distress
iv. Can be used while a patient is on CPAP
v. Can easily be adapted to a nonrebreathing mask

Question 53

Patient assessment includes finding out which medications the patient is currently taking

Answer 53

This information may provide vital clues to the patient’s condition.
1. May help guide your treatment
2. May be extremely useful to the emergency department physician
3. Can help you determine a chronic or underlying condition when a patient is unable to relate his or her medical history
C. Discover what the patient takes and transport the medications or a list of them with you to the emergency department.
D. Ask about any nonprescription drugs (eg, OTC, herbal, or illegal drugs).
E. Implications for EMS providers
1. Do not underestimate the importance of obtaining a thorough medication history.
2. Medications are frequently not taken as prescribed.
3. Consider a patient’s medication in the context of the clinical encounter.
4. Patient medications may significantly alter the clinical presentation of many acute medical conditions or injuries.
a. Beta adrenergic blocking agents
b. Calcium channel blockers
c. Antiplatelet and anticoagulant medications

Question 54

Medication Errors

Answer 54

A. A medication error is inappropriate use of a medication that could lead to patient harm.
B. Ensure that the environment does not contribute to errors.
1. Ensure lighting is sufficient.
2. Organize equipment.
3. Limit distractions as much as possible.
4. Consider using a “cheat sheet” to help yourself remember all crucial steps to medication administration.
C. If a medication error does take place:
1. Rapidly provide any appropriate patient care that is required.
2. Notify medical control as quickly as possible.
3. Follow your local protocols.
4. Document the incident thoroughly, accurately, and honestly.
5. Talk with your supervisor or medical director.
a. Represents an opportunity to learn
b. Identifies areas to target during quality improvement

Question 55

Vasodilation

Answer 55

is the widening of blood vessels as a result of the relaxation of the blood vessel’s muscular walls. Vasodilation is a mechanism to enhance blood flow to areas of the body that are lacking oxygen and/or nutrients

Question 56

Nitroglycerin

Answer 56

works by relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load

Question 57

Suspension

Answer 57

are defined as finely divided undissolved drugs dispersed in liquid vehicles

Question 58

Atorvastatin

Answer 58

It works by reducing the amount of cholesterol made by the liver. Lowering “bad” cholesterol and triglycerides **and raising “good” cholesterol **decreases the risk of heart disease and helps prevent strokes and heart attacks.

Question 59

Amlodipine

Answer 59

Amlodipine is used with or without other medications to treat high blood pressure.

Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Amlodipine belongs to a class of drugs known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily.

Question 60

glucose

Answer 60

glucose, one of a group of carbohydrates known as simple sugars (monosaccharides). Glucose (from Greek glykys; “sweet”) has the molecular formula C6H12O6. It is found in fruits and honey and is the major free sugar circulating in the blood of higher animals.

Question 61

Oxygen delivery devices (flow meter)

Answer 61

Oxygen delivery devices such as a nasal cannula, venturi mask, and high-flow nasal cannula can deliver varying FiO2. A patient breathing ambient air is inhaling a FiO2 of 21%. Oxygen delivery devices determine the flow rate and FiO2 based on predicted equipment algorithms. The conventional prediction model states that for every liter of oxygen supplied, the FiO2 increases by 4%. Therefore, a nasal cannula set at a 1 L/min flow rate can increase FiO2 to 24%, 2 L/min to 28%, 3 L/min to 32%, 4 L/min to 36%, 5 L/min to 40%, and 6 L/min to 44%.

Question 62

Hypertension

Answer 62

Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated. People with high blood pressure may not feel symptoms. The only way to know is to get your blood pressure checked.