Standard

 

EMS 129 - Pharmacology

Course Description

This unit is designed to help the Paramedic implement a patient management plan based on principles and applications of pharmacology.  Discussion of pharmacology includes historical trends, names and sources of drugs, classifications, sources of information, legislation and schedules of controlled drugs, standardization of drugs, investigational drugs and standardized drug profiles.  Other topics include general properties and forms of drugs, venous access, routes of administration, interactions, storage, and special considerations in drug therapy for pregnant patients, pediatrics, and geriatrics.  Also discussed are personal responsibility issues, legal, moral, and ethical responsibilities as well as therapeutically effective drug administration.  Detailed reviews of the autonomic nervous system will be discussed to enhance understanding of the mechanism or drug actions where pharmacokinetics and pharmacodynamics will be integrated.  Paramedics will learn to recognize and understand patient-prescribed, over-the-counter and other types of medications.  This course provides instruction on topics in Division 1 (Preparatory), Section 7 (Pharmacology) and Section 8 (Venous Access/Medication Administration) of the USDOT/NHTSA Paramedic National Standard Curriculum.

 

Competency Areas

Hours

 

Drug Sources

Class

4

Medical/legal considerations

D. Lab

3

Classifications and profiles

P. Lab/O.B.I.

0

Pharmacokinetics and pharmacodynamics

Credit

2

Venous access

 

 

Drug administration

 

 

Integration of assessment findings and pharmacological therapy

 

 

Special considerations

 

 

 

 

 

Prerequisite/Corequisite:

MAT 101 (General Math)/Corequisite

 

 

Course Guide

 

Competency

After completing this section, the student will:

Hours

Class

D.Lab

P.Lab/

O.B.I.
DRUG SOURCES

     

     

     

 

 

 

 

 
MEDICAL/LEGAL CONSIDERATIONS

 

 

 

 

 

 

 

 
CLASSIFICATIONS AND PROFILES

 

 

 

 

 

 

 

 
PHARMACOKINETICS AND PHARMACODYNAMICS

 

 

 

 

 

 

 

 

 
VENOUS ACCESS

 

 

 

 

 

 

 

 
DRUG ADMINISTRATION

 

 

 

 

 

 

 

 
INTEGRATION OF ASSESSMENT FINDINGS AND PHARMACOLOGICAL THERAPY

 

 

 

 

 

 

 

 
SPECIAL CONSIDERATIONS

 

 

 

 

UNIT TERMINAL OBJECTIVE

1-7     At the completion of this unit, the paramedic student will be able to integrate pathophysiological principles of pharmacology and the assessment findings to formulate a field impression and implement a pharmacologic management plan.  

 

COGNITIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

1-7.1  Describe historical trends in pharmacology. (C-1)

1-7.2  Differentiate among the chemical, generic (nonproprietary), and trade (proprietary) names of a drug. (C-3)

1-7.3  List the four main sources of drug products. (C-1)

1-7.4  Describe how drugs are classified. (C-1)

1-7.5  List the authoritative sources for drug information. (C-1)

1-7.6  List legislative acts controlling drug use and abuse in the United States. (C-1)

1-7.7  Differentiate among Schedule I, II, III, IV, and V substances. (C-3)

1-7.8  List examples of substances in each schedule. (C-1)

1-7.9  Discuss standardization of drugs. (C-1)

1-7.10         Discuss investigational drugs, including the Food and Drug Administration (FDA) approval process and the FDA classifications for newly approved drugs. (C-1)

1-7.11         Discuss special consideration in drug treatment with regard to pregnant, pediatric and geriatric patients. (C-1)

1-7.12         Discuss the paramedic's responsibilities and scope of management pertinent to the administration of medications. (C-1)

1-7.13         Review the specific anatomy and physiology pertinent to pharmacology with additional attention to autonomic pharmacology. (C-1)

1-7.14         List and describe general properties of drugs. (C-1)

1-7.15         List and describe liquid and solid drug forms. (C-1)

1-7.16         List and differentiate routes of drug administration. (C-3)

1-7.17         Differentiate between enteral and parenteral routes of drug administration. (C-3)

1-7.18         Describe mechanisms of drug action. (C-1)

1-7.19         List and differentiate the phases of drug activity, including the pharmaceutical, pharmacokinetic, and pharmacodynamic phases. (C-3)

1-7.20         Describe the process called pharmacokinetics, pharmocodynamics, including theories of drug action, drug-response relationship, factors altering drug responses, predictable drug responses, iatrogenic drug responses, and unpredictable adverse drug responses. (C-1)

1-7.21         Differentiate among drug interactions. (C-3)

1-7.22         Discuss considerations for storing and securing medications. (C-1)

1-7.23         List the component of a drug profile by classification. (C-1 )

1-7.24         List and describe drugs that the paramedic may administer according to local protocol. (C-1)

1-7.25         Integrate pathophysiological principles of pharmacology with patient assessment. (C-3)

1-7.26 Synthesize patient history information and assessment findings to form a field impression. (C-3)

1-7.27         Synthesize a field impression to implement a pharmacologic management plan. (C-3)

drugs. (C-3)

 

AFFECTIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

1-7.29         Serve as a model for obtaining a history by identifying classifications of drugs. (A-3)

1-7.30         Defend the administration of drugs by a paramedic to affect positive therapeutic affect. (A-3)

1-7.31         Advocate drug education through identification of drug classifications. (A-3)

 

PSYCHOMOTOR OBJECTIVES

None identified for this unit.

 

DECLARATIVE

 

I.        Historical trends in pharmacology

A.       Ancient health care

B.      The pre- and post-renaissance period

C.      Modern health care

D.      The present period of change

E.      New trends in health care and pharmaceutics

1.       Expansion of consumer health education results from the consumer's motivation to take responsibility for their health and disease prevention

2.       Research is directed to discover new treatments, cures, or methods to prevent disease processes that limit growth, everyday living, or average life span

3.       Orphan drugs developed to treat rare and chronic diseases

 

II.       Names of drugs

A.       Drugs - chemical agents used in the diagnosis, treatment, or prevention of disease

B.      Pharmacology -  the study of drugs and their actions on the body

C.      Chemical name - a precise description of the drug's chemical composition and molecular structure

D.      Generic name or non-proprietary name

1.       Official name approved by the FDA

2.       Usually suggested by the first manufacturer

E.      Trade or proprietary name - the brand name registered to a specific manufacturer or owner

F.       Official name - the name assigned by USP

 

III.      Sources of drugs

A.       Plants

1.       Alkaloids

2.       Glycosides

3.       Gums

4.       Oils

B.      Animals and humans

C.      Minerals or mineral products

D.      Chemical substances made in the laboratory

 

IV.      Drug Classification

A.       Drugs are classified

1.       By body system

2.       Class of agent

3.       Mechanism of action

 

V.       Sources of drug information

A.       AMA Drug Evaluation

B.      Physician's Desk Reference (PDR)

C.      Hospital Formulary (HF)

D.      Drug inserts

E.      Other texts, sources

 

VI.      United States drug legislation

A.       Purpose for drug legislation

1.       To protect the public from adulterated or mislabeled drugs

B.      History of drug legislation and its effects

1.       Pure Food and Drug Act, 1906

2.       Harrison Narcotic Act, 1914

3.       Federal Food, Drug, and Cosmetic Act, 1938

C.      Food and Drug Administration

 

VII.     Schedule of controlled substances

A.       Controlled Substances Act, 1970 (Comprehensive Drug Abuse Prevention and Control Act, 1970)

B.      Purpose for scheduling controlled substances, based upon abuse potential

C.      Classification of drugs into numbered levels or schedules (I to V)

D.      Schedules

1.       Schedule I

a.       High abuse potential

b.       No currently accepted medical use

(1)      For research, analysis, or instruction only

(2)      May lead to severe dependence

c.       Examples

(1)      Heroin

(2)      LSD

(3)      Mescaline

2.       Schedule II

a.       High abuse potential

b.       Accepted medical uses; may lead to severe physical and/ or psychological dependence

c.       Examples

(1)      Opium

(2)      Morphine

(3)      Codeine

(4)      Oxycodone

(5)      Methadone

(6)      Cocaine

(7)      Secobarbital

3.       Schedule III

a.       Less abuse potential than drugs in Schedules I and II

b.       Accepted medical uses - may lead to moderate/ low physical dependence or high psychologic dependence

c.       Examples

(1)      Preparations containing limited opioid quantities, or combined with one or more active ingredients that are noncontrolled substances

(a)      Acetaminophen with codeine

(b)      Aspirin with codeine

4.       Schedule IV

a.       Lower abuse potential compared to Schedule III

b.       Accepted medical uses - may lead to limited physical or psychological dependence

c.       Examples

(1)      Phenobarbital

(2)      Diazepam

(3)      Lorazepam

5.       Schedule V

a.       Low abuse potential compared to schedule IV

b.       Accepted medical uses - may lead to limited physical or psychologic dependence

c.       Examples

(1)      Medications, generally for relief of coughs or diarrhea, containing limited quantities of certain opioid controlled substances

 

VIII.    Standardization of drugs

A.       Standardization is a necessity

B.      Techniques for measuring a drug's strength and purity

1.       Assay

2.       Bioassay

C.      The Unites States Pharmacopeia (USP)

1.       Official volumes of drug standards               

D.      Other reference books and guides

 

IX.      Investigational drugs

A.       Prospective drugs may take years to progress through the FDA testing sequence

1.       Animal studies to ascertain

a.       Toxicity

b.       Therapeutic index

c.       Modes of absorption, distribution, metabolism (biotransformation), and excretion

2.       Human studies

 

B.      FDA approval process

1.       Phases of investigation

2.       New drug application

3.       Abbreviated new drug application

C.      FDA classifications for newly approved drugs, 1992

1.       Numerical classification

2.       Letter classification

 

X.       Special considerations in drug therapy

A.       Pregnant patients

1.       Before using any drug during pregnancy, the expected benefits should be considered against the possible risks to the fetus

2.       The FDA has established a scale (Categories A, B, C, D, and X) to indicate drugs that may have documented problems in animals and/ or humans during pregnancy

3.       Many drugs are unknown to cause problems in animals and/ or humans during pregnancy

4.       Pregnancy causes a number of anatomical and physiological changes

5.       Drugs may cross the placenta or through lactation

B.      Pediatric patients

1.       Based on the child's weight or body surface area

2.       Special concerns for neonates

3.       Length-based resuscitation tape

C.      Geriatric patients

1.       The physiological effects of aging can lead to altered pharmacodynamics and pharmacokinetics

 

XI.      The scope of management

A.       Paramedics are held responsible for safe and therapeutically effective drug administration

B.      Paramedics are personally responsible - legally, morally, and ethically - for each drug they administer

C.      Paramedics

1.       Use correct precautions and techniques

2.       Observe and document the effects of drugs

3.       Keep their knowledge base current to changes and trends in pharmacology

4.       Establish and maintain professional relationships

5.       Understand pharmacology

6.       Perform evaluation to identify drug indications and contraindications

7.       Seek drug reference literature

8.       Take a drug history from their patients including:

a.       Prescribed medications

(1)      Name

(2)      Strength

(3)      Daily dosage

 

b.       Over-the-counter medications

c.       Vitamins

d.       Drug reactions

9.       Consult with medical direction

 

XII.     Autonomic pharmacology

A.       Nervous system organization and function

1.       Characteristics of nervous system components

a.       Central nervous system

b.       Peripheral nervous system

c.       Somatic system

d.       Autonomic nervous system (ANS)

e.       Sympathetic branch of ANS

f.        Parasympathetic branch of ANS

B.      Peripheral nervous system characteristics

C.      Autonomic nervous system characteristics

1.       Parasympathetic and sympathetic characteristics

2.       Autonomic antagonists

3.       Physiological antagonism between sympathetic and parasympathetic discharge - organ responses

D.      Direction of sympathetic influences

E.      Neurochemical transmission

1.       Events involved in neurochemical transmission

2.       Activities within the synapse

3.       Synthesis of acetylcholine

F.       Other receptors

1.       Catecholamines and related substances

a.       Dopamine

b.       Norepinephrine

c.       Epinephrine

d.       Serotonin

2.       Agonist-gated ion channel receptors and G-protein-linked receptors

3.       Neuroactive peptides

a.       Endorphins

G.      Effector cell response

1.       Second messenger cellular amplification systems

2.       Receptor down-regulation

3.       Receptor up-regulation

H.      Termination of neurotransmission

I.        Altering neurotransmission with drugs

1.       Modification of chemical transmission by drugs

J.       Receptor location and selective drug action

1.       Autonomic neurotransmitters

2.       Acetylcholine (cholinergic) receptor locations

3.       Norepinephrine (adrenergic) receptor locations

K.      Selective drug action - nicotinic and muscarinic receptors

1.       Nicotinic receptor locations

2.       Muscarinic receptor locations

L.       Biological model systems and receptor characterization

M.      Receptor structure

N.      Synaptic control mechanisms

 

XIII.    General properties of drugs

A.       Drugs do not confer any new functions on a tissue or organ in the body, they only modify existing functions

B.      Drugs in general exert multiple actions rather than a single effect

C.      Drug action results from a physiochemical interaction between the drug and a functionally important molecule in the body

D.      Drugs that interact with a receptor to stimulate a response are known as agonists

E.      Drugs that attach to a receptor but do not stimulate a response are called antagonists

F.       Drugs that interact with a receptor to stimulate a response, but inhibit other responses are called partial agonists

G.      Once administered, drugs go through four stages

1.       Absorption

2.       Distribution

3.       Metabolism

4.       Excretion

 

XIV.    Drug forms

A.       Liquid drugs

1.       Solutions

2.       Tinctures

3.       Suspensions

4.       Spirits

5.       Emulsions

6.       Elixirs

7.       Syrups

B.      Solid drug forms

1.       Pills

2.       Powders

3.       Tablets

4.       Suppositories

5.       Capsules

C.       Gas forms

 

XV.     Overview of the routes of drug administration

A.       The mode of drug administration effects the rate at which onset of action occurs and may effect the therapeutic response that results

B.      The choice of the route of administration is crucial in determining the suitability of a drug

C.      Drugs are given for either their local or systemic effects

D.      The routes of drug administration are categorized as

 

 

 

XVI.    Routes of medication administration

A.       Inhalation route (nebulized medications)

B.      Enteral (drugs administered along any portion of the gastrointestinal tract)

a.       Sublingual

b.       Buccal

c.       Oral

d.       Rectal

e.       Nasogastric

C.      Parenteral (any medication route other than the alimentary canal)

a.       Subcutaneous

b.       Intramuscular

c.       Intravenous

d0      Intrathecal

e0      Pulmonary

f0       Intralingual

g0      Intradermal

h0      Transdermal

i0       Umbilical

j0       Intraosseous

k0      Nasal

D0     Endotracheal

 

XVII    Mechanisms of drug action

A0      To produce optimal desired or therapeutic effects, a drug must reach appropriate concentrations at its site of action

B0     Molecules of the chemical compound must proceed from point of entry into the body to the tissues with which they react

C0     The magnitude of the response depends on the dosage and the time course of the drug in the body

D0     Concentration of the drug at its site of action is influenced by various processes, which are divided into three phases of drug activity

1        Pharmaceutical

a0      Disintegration of dosage form

b0      Dissolution of drug

2        Pharmacokinetic

a0      Absorption

b0      Distribution

c0      Metabolism

d0      Excretion

3        Pharmacodynamic

a0      Drug-receptor interaction

 

XVIII    Pharmacokinetics

A0      Passive transport

B0     Active transport

C0     Absorption

 

1        Variables that affect drug absorption

a0      Nature of the absorbing surface

b0      Blood flow to the site of administration

c0      Solubility of the drug

d0      pH

e0      Drug concentration

f0       Dosage form

g0      Routes of drug administration

h0      Bioavailability

2        Mechanisms involved in absorption

a0      Diffusion

b0      Osmosis

c0      Filtration

D0     Distribution

1        Drug reservoirs

a0      Plasma protein binding

b0      Tissue binding

2        Barriers to drug distribution

a0      Blood-brain barrier

b0      Placental barrier

E0     Biotransformation

1        Active metabolites

2        Inactive metabolites

F0      Excretion

1        Organs of excretion

a0      Kidneys

b0      Intestine

c0      Lungs

d0      Sweat and salivary glands

e0      Mammary glands

 

XIX     Pharmacodynamics

A0      Theories of drug action -  most drugs produce their effects by one of the following ways

1        Drug-receptor interaction

a0      Agonists

b0      Antagonists

c0      Affinity

d0      Efficacy

e0      Types of receptors

(1)      Beta1

(2)      Beta2

(3)      Alpha1

(4)      Alpha2

(5)      Dopaminergic

(6)      Others

2        Drug-enzyme interaction

3        Nonspecific drug interaction

 

 

 

B0     Drug-response relationship

1        Plasma level profile of a drug

2        Biologic half-life

3        Therapeutic threshold or minimum effective concentration

4        Therapeutic index

C0     Factors altering drug responses

1        Age

2        Body mass

3        Sex

4        Environmental milieu

5        Time of administration

6        Pathologic state

7        Genetic factors

8        Psychologic factors

D0     Predictable responses

1        Desired action

2        Side effects

E0     Iatrogenic responses (adverse effects produced unintentionally)

F0      Unpredictable adverse responses

1        Drug allergy (medications frequently implicated in allergic reactions)

2        Anaphylactic reaction

3        Delayed reaction ("serum sickness")

4        Hypersensitivity

5        Idiosyncracy

6        Tolerance

7        Cross tolerance

8        Tachyphylaxis

9        Cumulative effect

10      Drug dependence

11      Drug interaction

12      Drug antagonism

13      Summation (addition or additive effect)

14      Synergism

15      Potentiation

16      Interference

 

XX      Drug interactions

A0      Variables influencing drug interaction include

1        Intestinal absorption

2        Competition for plasma protein binding

3        Drug metabolism or biotransformation

4        Action at the receptor site

5        Renal excretion

6        Alteration of electrolyte balance

B0     Drug-drug interactions

C0     Other drug interactions

1        Drug-induced malabsorption of foods and nutrients

2        Food-induced malabsorption of drugs

3        Alteration of enzymes

4        Alcohol consumption

5        Cigarette smoking

6        Food-initiated alteration of drug excretion

D0     Drug incompatibilities - occur when drugs are mixed before administration

 

 

XXI     Drug storage

A0      Certain precepts should guide the manner in which drugs are secured, stored, distributed, and accounted for

B0     Refer to local protocol

C0     Drug potency can be affected by

1        Temperature

2        Light

3        Moisture

4        Shelf life

D0     Applies also to diluents

E0     Security of controlled medications

1        Procedures and other measures to ensure the security of controlled medications

 

XXII    Components of a drug profile

A0      Drug names

B0     Classification

C0     Mechanisms of action

D0     Indications

E0     Pharmacokinetics

F0      Side/ adverse effects

G0     Routes of administration

H0     How supplied

I0       Dosages

J0      Contraindications

K0     Considerations for pediatric patients, geriatric patients, pregnant patients, and other special patient groups

L0      Other profile components

 

XXIII    Drugs by classifications

A0      Analgesics and antagonists

1        Nonprescription analgesic-antipyretics

2        Opioid analgesics-agonists

3        Adjuvant medications

4        Opioid antagonists

5        Opioid agonist-antagonist agents

B0     Anesthetics

1        Anesthesia

2        Significant drug interactions

3        Special anesthesia considerations

4        Types of anesthetics

a0      Inhalation anesthetics

b0      Intravenous anesthetics

c0      Ultra-short-acting barbiturates

d0      Dissociative anesthetic

e0      Neuroleptanesthesia

5        Local anesthesia

a0      Surface or topical anesthesia

6        Anesthesia by injection

 

C0     Antianxiety, sedative, and hypnotic drugs

1        Physiology of sleep

2        Benzodiazepines

3        Benzodiazepine antidote

4        Barbiturates

5        Miscellaneous sedatives and hypnotics

a0      Antianxiety agents/ sedatives

b0      Hypnotics

D0     Anticonvulsants

1        Anticonvulsant therapy

2        Hydantoins

3        Barbiturates

4        Succinimides

5        Diones

6        Benzodiazepines

7        Other Anticonvulsants

E0     Central nervous system stimulants

1        Anorexiant drugs

2        Amphetamines

3        Other central nervous system stimulants

F0      Psychotherapeutic drugs

1        The central nervous system and emotions

2        The role of drug therapy in psychiatry

3        Antipsychotic or neuroleptic agents

a0      Phenothiazine derivatives

b0      Butyrophenone derivatives

c0      Dihydroindolone derivatives

d0      Dibenzoxapine derivatives

4        Antidepressant therapy

a0      Monoamines

b0      Tricyclic antidepressants

c0      Monoamine oxidase inhibitor antidepressants

d0      Antimanic drugs

G0     Drugs for specific CNS-peripheral dysfunctions

1        Parkinson's disease

2        Drugs with central anticholinergic activity

a0      Anticholinergic agents

b0      Drugs affecting brain dopamine

(1)     Drugs that increase brain levels of dopamine

(2)     Dopamine-releasing drug

(3)     Dopaminergic agonists

c0      Monoamine oxidase inhibitor

H0     Drugs affecting the parasympathetic nervous system

1        Cholinergic drugs

a0      Direct-acting cholinergic drugs (choline esters)

b0      Indirect-acting cholinergic drugs

c0      Drugs used to treat myasthenia gravis

2        Cholinergic blocking drugs

a0      Muscarinic blocking drugs

b0      Belladonna alkaloids

c0      Synthetic substitutes for atropine

 

3        Ganglionic stimulating drugs

a0      Nicotine

4        Ganglionic blocking drugs

 

I0       Drugs affecting the sympathetic (adrenergic) nervous system

1        Adrenergic drugs

a0      Direct-acting adrenergic drugs

(1)     Catecholamines

b0      Drugs used for hypoperfusion

c0      Indirect- and dual-acting adrenergic drugs

2        Adrenergic blocking drugs

a0      Alpha-adrenergic blocking drugs

b0      Noncompetitive, long-acting antagonists

c0      Competitive, short-acting antagonists

d0      Beta-adrenergic blocking agents

J0      Skeletal muscle relaxants

1        Central-acting skeletal muscle relaxants

2        Direct-acting skeletal muscle relaxants

K0     Drugs affecting the cardiovascular system

1        Antidysrhythmics

a0      Group I-A Drugs

b0      Group I-B Drugs

c0      Group I-C Drugs

d0      Group I Drugs (A, B, C)

e0      Group II Drugs

f0       Group III Drugs

g0      Group IV Drugs (miscellaneous drug group)

2        Antihypertensives

a0      Diuretic drugs

(1)     Thiazides

(2)     Loop diuretics

(3)     Potassium-sparing agents

b0      Adrenergic inhibiting (sympatholytic) agents

(1)     Beta-adrenergic blocking agents

(2)     Centrally-acting adrenergic inhibitors

(3)     Peripheral adrenergic inhibitors

(4)     Rauwolfia derivatives

(5)     Alpha-adrenergic blocking drugs

c0      Angiotensin-converting enzyme inhibitors

d0      Calcium channel blocking agents

e0      Vasodilators

(1)     Arteriolar dilator drugs

(2)     Arterial and venous dilator drugs

f0       Ganglionic blocking drugs

g0      Monoamine oxidase inhibiting drugs

3        Cardiac glycosides

a0      Digitalis glycosides

b0      Miscellaneous agents

4        Calcium channel blockers

5        Vasodilators

a0      Antianginal drugs

b0      Nitrates

c0      Drugs for peripheral occlusive arterial disease

d0      Other vasodilating agents

6        Antihemorrheologic agents

 

L0      Anticoagulants, thrombolytics, and blood components

1        Anticoagulant drugs

a0      Parenteral anticoagulant drugs

b0      Parenteral anticoagulant antagonists

c0      Oral anticoagulant therapy

d0      Oral anticoagulant antagonist - vitamin K

2        Thrombolytic therapy

3        Antihemophilic agents

4        Hemostatic agents

5        Blood and blood components

a0      Replacement therapies

M0     Antihyperlipidemic drugs

N0     Diuretics

1        Proximal tubule diuretics

2        Diluting segment diuretics (thiazide and thiazide-type drugs)

3        Loop diuretics

4        Distal tube diuretics/ potassium-sparing diuretics

5        Osmotic diuretics

6        Diuretic combinations

O0     Drug therapy for renal system dysfunction

P0     Mucokinetic and bronchodilator drugs

1        Mucokinetic drugs

a0      Diluents

b0      Aerosol therapy

c0      Mucolytic drugs

d0      Drugs that antagonize bronchial secretions

2        Bronchodilator drugs

a0      Sympathomimetic drugs

(1)     Nonselective adrenergic drugs

(2)     Nonselective beta-adrenergic drugs

(3)     Selective beta2 receptor drugs

(4)     Catecholamine beta2 receptor agents

(5)     Noncatecholamine beta2 receptor drugs

3        Xanthine derivatives

4        Prophylactic asthmatic drugs

a0      Inhalation corticosteroid therapy

Q0     Oxygen and miscellaneous respiratory agents

1        Drugs that affect the respiratory center

a0      Oxygen therapy

b0      Direct respiratory stimulants

c0      Reflex respiratory stimulants

d0      Respiratory depressants

2        Cough suppressants

a0      Opioid antitussive drugs

b0      Nonopioid antitussive drugs

3        Nasal decongestants

4        Antihistamines

5        Serotonin

6        Antiserotonin

 

 

R0     Drugs affecting the gastrointestinal system

1        Drugs that affect the stomach

a0      Antacid combinations

b0      Antiflatulents

c0      Digestants

d0      Antiemetics

e0      Cannabinoids

f0       Emetic agents

g0      Cytoprotective agents

h0      H2 receptor antagonists

2        Drugs affecting the lower gastrointestinal tract

a0      Laxatives

b0      Antidiarrheals

S0     Ophthalmic drugs

1        Antiglaucoma agents

2        Mydriatic and cycloplegic agents

3        Antiinfective/ antiinflammatory agents

4        Topical anesthetic agents

5        Other ophthalmic preparations

T0      Drugs affecting the ear

1        Antibiotic ear preparations

2        Steroid and antibiotic combinations

3        Miscellaneous preparations

U0     Drugs affecting the pituitary

1        Anterior pituitary hormones

2        Posterior pituitary hormones

V0      Drugs affecting the parathyroid and thyroid

1        Thyroid preparations

2        Antithyroid agents

3        Iodine products

4        Thiomide derivatives

W0     Drugs affecting the adrenal cortex

1        Glucocorticoids

2        Mineralocorticoids

3        Antiadrenals (adrenal steroid inhibitors)

X0      Drugs affecting the pancreas

1        Insulin preparations

2        Oral hypoglycemic agents

3        Hyperglycemic agents

Y0      Drugs affecting the female reproductive system

1        Female sex hormones

a0      Estrogens

b0      Progesterone and progestins

2        Oral contraceptives

3        Ovulatory stimulants and drugs used for infertility

Z0      Drugs for labor and delivery

1        Drugs affecting the uterus

a0      Oxytocics

b0      Premature labor inhibitors

 

 

AA0    Drugs affecting the male reproductive system

1        Testosterone

BB0   Drugs affecting sexual behavior

1        Drugs used to impair libido and sexual gratification

2        Drugs used to enhance libido and sexual gratification

CC0   Antineoplastic agents

DD.    Drugs used in infectious disease and inflammation

EE.    Antibiotics

1.       Penicillins

2.       Cephalosporins and related products

3.       Macrolide antibiotics

4.       Tetracyclines

5.       Miscellaneous antibiotics

FF.     Antifungal and antiviral drugs

1.       Antifungal drugs

2.       Antiviral drugs

GG.    Other antimicrobial drugs and antiparasitic drugs

1.       Antimalarial medications

2.       Antituberculous agents

3.       Antiamebiasis agents

4.       Anthelmintic agents

5.       Leprostatic agents

HH.    Nonsteroidal antiinflammatory drugs

II.       Uricosuric drugs

JJ.     Serums, vaccines, and other immunizing agents

KK.    Drugs affecting the immunologic system

1.       Immunosuppressants

2.       Immunomodulating agents

LL.     Dermatologic drugs

1.       General dermatologic preparations

2.       Prophylactic agents

MM.    Vitamins and minerals

1.       Vitamins

a.       Fat-soluble vitamins

b.       Water-soluble vitamins

2.       Minerals

NN.    Fluids and electrolytes

1.       Parenteral solutions

2.       Electrolytes

OO.    Antidotes/ overdoses

1.       Specific to the type of poison

a.       Elimination

 

 

 

UNIT TERMINAL OBJECTIVE

1-8     At the completion of this unit, the paramedic student will be able to safely and precisely access the venous circulation and administer medications.

 

COGNITIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

1-8.1  Review the specific anatomy and physiology pertinent to medication administration. (C-1)

1-8.2  Review mathematical principles. (C-1)

1-8.3  Review mathematical equivalents. (C-1)

1-8.4  Differentiate temperature readings between the Centigrade and Fahrenheit scales. (C-3)

1-8.5  Discuss formulas as a basis for performing drug calculations. (C-1)

1-8.6  Discuss applying basic principles of mathematics to the calculation of problems associated with medication dosages. (C-1)

1-8.7  Describe how to perform mathematical conversions from the household system to the metric system. (C-1)

1-8.8  Describe the indications, equipment needed, technique used, precautions, and general principles of peripheral venous or external jugular cannulation. (C-1)

1-8.9  Describe the indications, equipment needed, technique used, precautions, and general principles of intraosseous needle placement and infusion. (C-1)

1-8.10         Discuss legal aspects affecting medication administration. (C-1)

1-8.11         Discuss the "six rights" of drug administration and correlate these with the principles of medication administration. (C-1)

1-8.12         Discuss medical asepsis and the differences between clean and sterile techniques. (C-1)

1-8.13         Describe use of antiseptics and disinfectants. (C-1)

1-8.14         Describe the use of universal precautions and body substance isolation (BSI) procedures when administering a medication. (C-1)

1-8.15         Differentiate among the different dosage forms of oral medications. (C-3)

1-8.16         Describe the equipment needed and general principles of administering oral medications. (C-3)

1-8.17         Describe the indications, equipment needed, techniques used, precautions, and general principles of administering medications by the inhalation route. (C-3)

1-8.18         Describe the indications, equipment needed, techniques used, precautions, and general principles of administering medications by the gastric tube. (C-3)

1-8.19         Describe the indications, equipment needed, techniques used, precautions, and general principles of rectal medication administration. (C-3)

1-8.20         Differentiate among the different parenteral routes of medication administration. (C-3)

1-8.21         Describe the equipment needed, techniques used, complications, and general principles for the preparation and administration of parenteral medications. (C-1)

1-8.22         Differentiate among the different percutaneous routes of medication administration. (C-3)

1-8.23         Describe the purpose, equipment needed, techniques used, complications, and general principles for obtaining a blood sample. (C-1)

1-8.24         Describe disposal of contaminated items and sharps. (C-1)

1-8.25         Synthesize a pharmacologic management plan including medication administration. (C-3)

1-8.26         Integrate pathophysiological principles of medication administration with patient management. (C-3)

 

AFFECTIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

1-8.27         Comply with paramedic standards of medication administration. (A-1)

1-8.28         Comply with universal precautions and body substance isolation (BSI). (A-1)

1-8.29         Defend a pharmacologic management plan for medication administration. (A-3)

1-8.30         Serve as a model for medical asepsis. (A-3)

1-8.31         Serve as a model for advocacy while performing medication administration. (A-3)

1-8.32         Serve as a model for disposing contaminated items and sharps. (A-3)

 

 

 

PSYCHOMOTOR OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

1-8.33         Use universal precautions and body substance isolation (BSI) procedures during medication administration. (P-2)

1-8.34         Demonstrate cannulation of peripheral or external jugular veins. (P-2)

1-8.35         Demonstrate intraosseous needle placement and infusion. (P-2)

1-8.36         Demonstrate clean technique during medication administration. (P-3)

1-8.37         Demonstrate administration of oral medications. (P-2)

1-8.38         Demonstrate administration of medications by the inhalation route. (P-2)

1-8.39         Demonstrate administration of medications by the gastric tube. (P-2)

1-8.40         Demonstrate rectal administration of medications. (P-2)

1-8.41         Demonstrate preparation and administration of parenteral medications. (P-2)

1-8.42         Demonstrate preparation and techniques for obtaining a blood sample. (P-2)

1-8.43         Perfect disposal of contaminated items and sharps. (P-3)

 

 

 

DECLARATIVE

 

XXIV.  Review of mathematical principles

A.       Multiplication and division

B.      Roman numerals

C.      Fractions

D.      Decimal fractions

E.      Proportions

F.       Percent

 

XXV.   Mathematical equivalents used in pharmacology

A.       The metric system

B.      Conversions between the household and metric system    

C.      Fahrenheit scale for temperature reading

D.      Celsius (centigrade) scale for temperature reading

E.      Converting between Fahrenheit and Celsius temperatures

 

XXVI.  Calculating drug dosages

A.       Calculation methods

1.       Fraction method

2.       Ratio method

3.       Desired dose over available concentration method

B.      Calculating dosages

1.       Oral medications

a.       Capsules and tablets

b.       Liquids

2.       Parenteral medications

a.       Quantity (typically weight)

b.       Volume

c.       Units (e.g., insulin)

3.       Intravenous infusions

a.       Flow rates

b.       Flow rates for infants and children

c.       Total infusion time

d.       Other factors influencing flow rates

4.       Calculating dosages for infants and children

a.       Body weight

b.       Body surface area (BSA)

c.       Use of tables, charts, and other adjuncts

d.       Length-based resuscitation tapes

 

XXVII.  Medical direction

A.       Medication administration is bound by the paramedic's on-line or off-line medical direction

B.      Role of the medical director

C.      Patient management protocols

1.       Written standing orders

D.      Legal considerations - policies and procedures which specify regulations of medication administration

 

 

XXVIII. Principles of medication administration

A.       Local drug distribution system - policies which establish stocking and supply of drugs

B.      Paramedic's responsibility associated with the drug order

1.       Verification of the drug order

C.      The "six rights" of medication administration

1.       “Right" patient

2.       “Right” drug

3.       “Right” dose

4.       “Right” route

5.       “Right” time

6.       “Right” documentation

 

XXIX.  Medical asepsis

A.       Clean technique versus sterile technique

B.      Sterilization

C.      Antiseptics

D.      Disinfectants

 

XXX.   Universal precautions and body substance isolation (BSI) in medication administration

 

XXXI.  Venous access

A.       Intravenous cannulation

1.       General principles

2.       Types

a.       Peripheral

(1       General principles

(2       Indications

(3       Precautions

(4       Equipment

(5       Technique

(a       Extremity

i)       Indications

ii)       Precautions

iii)      Equipment

iv)      Procedure

(b       External jugular

i)       Indications

ii)       Precautions

iii)      Equipment

iv)      Procedure

b.       Central

 

 

 

B.      Intraosseous needle placement and infusion

1.       General Principles

2.       Indications

3.       Precautions

4.       Equipment

5.       Technique

 

 

XXXII.  Medication administration by the inhalation route

A.       Bronchdilators (beta agonist) medications

1.       Other medications

B.      Equipment

1.       Oxygen or compressed air source

2.       Small volume nebulizer (SVN)

a.       Other inhaler equipment

b.       Other adapter equipment

c.       Modified inhaler equipment

C.      Administering medications by the inhalation route

1.       Indications

2.       Techniques

3.       Precautions

4.       General principles of administering medications by the inhalation route

 

XXXIII. Enteral medication administration

A.       Oral administration of medications

1.       Dosage forms of solid-form and liquid-form oral medications

a.       Capsules

b.       Time-released capsules

c.       Lozenges

d.       Pills

e.       Tablets

f.        Elixirs

g.       Emulsions

h.       Suspensions

i.        Syrups

2.       Equipment

a.       Souffle cup

b.       Medicine cup

c.       Medicine dropper

d.       Teaspoons

e.       Oral syringes

f.        Nipples

3.       General principles for administration of solid-form and liquid-form oral medications

 

B.      Administration of medications by the gastric tube

1.       Indications for administering medications by the gastric tube

a.       Nasogastric tube

b.       Orogastric tube

2.       Required equipment

3.       Techniques used

4.       Precautions

5.       General principles for administration of medications by the gastric tube

C.      Rectal administration of medications

1.       Indications for rectal administration of medications

2.       Required equipment

3.       Techniques used

4.       Precautions

5.       General principles for rectal administration of medications

 

XXXIV. Parenteral administration of medications

A.       Parenteral routes

1.       Intradermal

2.       Subcutaneous

3.       Intramuscular

4.       Intravenous

5.       Intraosseous

6.       Percutaneous

B.      Reasons for parenteral administration of medications

C.      Equipment used in parenteral administration of medications

1.       Syringes

a.       Calibration of the syringe

b.       Prefilled syringes

2.       Needles

a.       Parts of the needle

3.       Selection of the syringe and needle

4.       Packaging of syringes and needles

5.       Packaging of parenteral medications

a.       Ampules

b.       Vials

c.       Prefilled syringes

d.       Other

6.       Intravenous (IV) administration sets

a.       Various types

b.       Macrodrip chamber-type

c.       Microdrip chamber-type

d.       Variety of extensions and other pieces of equipment

e.       Some IV administration sets are manufacturer specific

7.       Intravenous (IV) solutions

a.       Types of containers

b.       Variety of volumes

 

8.       “Piggyback” administration

a.       Primary IV infusion

b.       Secondary IV infusion

c.       Related equipment to connect secondary infusion to primary infusion

9.       Volume control intravenous set

a.       Various brands

D.      Preparation of parenteral medication

1.       Equipment needed for preparing a parenteral medication

2.       Standard procedures for preparing all parenteral medications

3.       Guidelines for preparing medications

a.       To prepare a medication from an ampule

b.       Reconstitution of a sterile powder

c.       Removal of a volume of liquid from a vial

d.       Preparing a drug from a mix-o-vial

e.       Preparing two medications in one syringe

E.      Administration of medication by the intradermal route

1.       Intradermal route: injections are made into the dermal layer of skin just below the epidermis

2.       Equipment needed for administration of a medication by the intradermal route

3.       Locate anatomical sites

4.       Technique for administration of medication by the intradermal route

5.       Documentation

 

F.       Administration of medication by the subcutaneous route

1.       Subcutaneous route: injections are made into the loose connective tissue between the dermis and muscle layer

2.       Equipment needed for administration of a medication by the subcutaneous route

3.       Locate anatomical sites

a.       Upper arms

b.       Anterior thighs

c.       Abdomen

d.       Sublingual

4.       Technique for administration of medication by the subcutaneous route

5.       Precautions

G.      Administration of medication by the intramuscular route

1.       Intramuscular route - injections are made by penetrating a needle through the dermis and subcutaneous tissue into the muscle layer

2.       Equipment needed for administration of a medication by the intramuscular route

3.       Locate anatomical sites for adults and children

a.       Vastus lateralis muscle

b.       Rectus femoris muscle

c.       Gluteal area

d.       Deltoid muscle

4.       Technique for administration of medication by the intramuscular route

5.       Precautions

H.      Administration of medication by the intravenous route

1.       Intravenous route

a.       Places the drug directly into the bloodstream

b.       Bypasses all barriers to drug absorption

2.       Drugs may be administered by direct injection with a needle and syringe, but more commonly drugs are given intermittently or by continuous infusion through an established peripheral or central line

3.       Purpose for a peripheral IV site

4.       Purpose for a central IV site

5.       Dosage forms for IV administration

6.       Equipment needed for administration of a medication by the peripheral or central IV route

7.       Anatomical sites for adults, children, and infants

a.       Peripheral access

b.       Central access

8.       General principles of IV medication administration

9.       Preparing an IV solution for infusion

a.       Equipment

b.       Technique

c.       Warming or cooling an IV solution, as indicated

10.     Adding medication to an existing IV solution

11.     Steps in performing venipuncture

12.     Steps in performing administration of medications into an established IV line

13.     Steps in performing administration of medication by a heparin lock

14.     Steps in adding a medication to an IV bag, bottle, or volume control

15.     Steps in adding a medication with a piggyback or secondary set

16.     Steps in changing to the next container of IV solution

17.     Steps in administering medication by a venous access device

a.       Equipment

b.       Technique

 

18.     Steps to discontinue an intravenous infusion

a.       Equipment

b.       Technique

19.     Steps in monitoring IV therapy

a.       Various types of infusion pumps

20.     Complications

a.       Phlebitis or infection

b.       Extravasation

c.       Air in tubing

d.       Circulatory overload and pulmonary edema

e.       Allergic reaction

f.        Pulmonary embolism

g.       Failure to infuse properly

 

I.        Administration of percutaneous medications

1.       Percutaneous route - application of a medication for absorption through the mucous membranes or skin

2.       Factors which influence the amount of medication absorbed through the skin or mucous membranes

3.       Methods of percutaneous administration of medications

4.       Steps in preparing percutaneous medications

5.       Topical medications - applied directly to the area of skin requiring treatment

a.       Common forms of topical medications

b.       Steps in administering topical medications

6.       Administering medications to mucous membranes

a.       Places where medications are commonly applied

(1       Under the tongue (sublingual)

(2       Against the cheek (buccal)

(3       In the eye

(4       In the nose

(5       In the ear

(6       Inhaled into the lungs

(a       Through an aerosol or nebulizer

(b       Through positive pressure ventilation

b.       Dosage forms

(1       Tablets

(2       Drops

(3       Ointments

(4       Creams

(5       Suppositories

(6       Metered-dose inhalers

c.       Equipment needed for administration of each type of medication

d.       Steps for the administration of the dosage form of medication to the place it is commonly applied

 

 

J.       Administration of medication by the intraosseous route

1.       Any solution or drug that can be administered intermittently or by continuous infusion can b