General Pharmacology and Pharmacology for the Soldier Medic
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General Pharmacology and Pharmacology for the Soldier Medic

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    General Pharmacology and Pharmacology for the Soldier Medic General Pharmacology and Pharmacology for the Soldier Medic Presentation Transcript

    • Department of Combat Medic Training C168W194 General Pharmacology and Pharmacology for the Soldier Medic
    • Terminal Learning Objective
      • Given a sick call medication,
      • Identify the class, indications, contraindications of common medication
      • IAW Nursing Drug Handbook Chapters 16, 45-47, 55, 59, 60, and 63 & Prehospital Trauma Life Support Chapter 21.
    • Antibiotics
      • What is an Antibiotic?
      • An antibiotic is a chemical compound that inhibits or abolishes the growth of microorganisms such as bacteria, fungi or protozoa.
      • What does an antibiotic do?
      • Inhibits or kills the growth of microorganisms such as bacteria, fungi and protozoa.
      • Indications?
      • Treat or prevent bacterial infections.
    • Antibiotic - Trick Question
      • If you knew the exact virus causing the patient’s illness, would you want a broad or narrow spectrum antibiotic and why?
      Neither. If you knew the infection was a specific bacteria , provide a narrow spectrum antibiotic. Antibiotics are NOT be used for known viral infections.
    • Antibiotics
      • Which form of antibiotic is most appropriate for: (Be prepared to defend your choices.)
      • An adult patient with a positive throat culture for Group A Streptococcus (AKA strep throat - a bacterial infection)
      • A Soldier sustains wounds in combat, has surgery and is currently recovering in ICU.
      • A small child has a bacterial infection, refusing to swallow pills.
      • A 6 year old has an abrasion to her elbow from a bicycle accident.
    • Antibiotics
      • Given which form of antibiotic, would your patient show signs of an allergic reaction the quickest? Why?
      Intravenous Absorption is extremely rapid and distribution of medication is immediately systemic when compared to other routes
    • Check on your Learning…
      • What are the advantages and disadvantages of oral antibiotics?
      Advantage Oldest method Safest Convenient Economical Easy to Administer Disadvantages Vomiting Requires cooperative patient. Slow absorption rate.
    • Non-Steroidal Anti - Inflammatory Drugs
      • What is easier to say than N on- S teroidal A nti – I nflammatory D rugs ?
      • NSAID !!!
      • NSAIDs can do three things.
      • Reduce fever - Antipyretic
      •   Reduce pain - Analgesics
      • Reduce swelling - Anti-inflammatory
    • NSAIDS
      • What NSAIDs have YOU taken and why?
      • Aspirin (ASA)
      • Ibuprofen
      • Naproxen
    • NSAIDs – Trick Question
      • You are working at a BAS in Iraq. A Soldier states he has been having lower back pain for one week. He has been taking aspirin, with minimal pain relief.
      • Should the Soldier continue taking the Aspirin? Why?
      • Stop taking ASA regardless of pain. Refer to MO. ASA is not indicated for military members in combat. ASA prolongs the clotting time of blood which may cause the service member to bleed excessively.
    • NSAIDS
      • If you were concerned a patient has overdosed on a NSAID, what signs / symptoms would you look for?
      • High pitch Tinnitus , Vertigo , Deafness
      • Hyperthermia (elevated body temperature)
      • Behavioral effects - CNS stimulation, followed by depression, agitation or confusion, followed by stupor/coma.
      • Respiratory stimulation - to the point of hyperventilation followed later by respiratory depression.
    • NSAIDS
      • What are the general warnings you should know about NSAIDS?
      • Possible hypersensitive reactions (ask about allergies)
      • NSAIDs may cause acute renal failure. (Drink water)
      •   Aspirin may cause:
      • Asthma symptoms to worsen
      • Peptic ulcer or gastric bleeding
      •   Do not give Aspirin to children. (Reye’s Syndrome)
      •  
    • Check on your Learning…
      • Q: What are three indications for a NSAID?
      • Q: What are common side effects of NSAIDS?
      A: Fever, Pain, Inflammation Gastric Irritation (limited to epigastric discomfort ) Heartburn Nausea Lack of Appetite Prolonged Clotting Time
    • Antihistamines
      • Your body reacts to substances,
      • for which it is allergic to,
      • by releasing histamines and leukotrienes . When released, how does each affect the body?
      • Histamines - gastric secretion, dilation of capillaries, constriction of bronchial smooth muscle and decreased blood pressure.
      • Leukotrienes - contribute to inflammation.
    • Antihistamines
      • Do antihistamines stop:
      • An allergic reaction?
      • NO
      • The body's antibodies and the foreign substance still react with one another
      • The production of histamines?
      • No
      • It blocks the action of the histamine on the tissue.
      • Protecting it from some of the histamine affects.
    • Check on your Learning…
      • Define Histamine.
      • Physically active substance found in plant and animal tissue. Released from mast cells as a part of an allergic reaction in humans.
      • Stimulates gastric secretions, dilation of capillaries, constriction of bronchial smooth muscle and decreased blood pressure.
      • Examples of antihistamines.
      • Allegra - Diphenhydramine - Loratadine
    • Analgesics
      • Why would someone need an analgesic?
      • Moderate to severe pain….
      • Operational and combat injuries
      • Traumatic amputations
      • Ballistic injuries
      •  Severe burns
      •  Crush injuries
    • Analgesics
      • If a person is allergic to a specific analgesic, do not administer.
      • Side Effects include:
      • Respiratory depression (with repeated doses)
      •   Nausea and/or vomiting
      • Constriction of the pupils and reduced pupillary reaction
    • Analgesics
      • You are responsible for 5 different analgesics:
      • Morphine
      • Fentanyl
      • Meloxicam (Mobic)
      • Acetaminophen (Tylenol)
      • Percocet
      • And one narcotic antagonist:
      • Naloxone (Narcan)
    • Morphine
      • What is the preferred route of morphine in a combat environment?
      • Intravascular (IV)
      • Why not intramuscular (IM)?
      • The IM route relies on adequate blood flow to the muscles. During shock the body shunts blood away from muscles and to vital organs. The medicine may remain in the muscle and not circulate thorough the body.
    • IV Morphine
      • Initial Dose
      • 5mg slow IV push over 1 to 2 minutes.
      • Dilute morphine with 5ml of Sterile Water for Injection or Normal Saline (NaCl)
      •   Repeated Doses
      • Every 5 minutes.
      • Most adults experience pain relief at 10-20mg
    • IM Morphine
      • Load the pre-filled cartridge into the injector device.
      • (usually at a dose of 5 or 10mg)
    • IM Morphine
      • Select the appropriate site (uninjured tissue) and administer the IM injection.
    • IM Morphine
      • If the Soldier is not given the full 10mg,
      • place the unused portion in another syringe
      • (if possible)
      • to utilize the full amount at a later time.
      • Don't waste medical supplies.
    • Morphine
      • After you administer morphine to the casualty, regardless of the route,
      • what remains to be completed?
      • Document every dose and the time administered.
      •   Monitor the casualty closely for adverse effects.
      • In the combat environment,
      • consider writing the letter "M" and time of injection the on the casualty's forehead.
    • Morphine Auto-Injectors
      • The U.S. military utilizes auto-injectors.
      • One auto-injector usually equals 10mg.
    • Morphine Auto-Injectors
    • Fentanyl (Actiq) Narcotic “Lollipop”
      • Indications
      • Moderate to severe pain in casualties who are alert and conscious.
      • Patients with known morphine allergies.
    • Fentanyl “Lollipop”
      • Contraindications
      •  Allergy to the medication or components
      • Caution in giving to a casualty that has already been given morphine.
      • This can increase the chances of respiratory depression and narcotic side effects.
    • Fentanyl “Lollipop”
      • Route
      • Transbuccal
      • Absorbed through the linings of the cheeks.
      • Dosage
      • 800 micro grams
      • Tape the lozenge stick to the patient’s finger. This is to protect the individual from overdosing.
      • Reassess every 15 minutes
    • You are the Medic
      • You administered 10 mg of morphine (IM) to a patient in severe pain.
      • Once you reached a MTF, the MO decides to administer an additional 5 mg IV.
      • Upon reassessment, you note the patient is lethargic and breathing at a rate of 6 breaths per minute.
      • What should you do?
      • Administer Naloxone (Narcan®)
    • Naloxone (Narcan®)
      • How does Narcan® work?
      • By binding with the same receptors in the brain that narcotics normally attach.
      • Naloxone blocks the narcotic from binding with brain receptors.
    • Naloxone (Narcan®)
      • Dosage
      • 0.4mg - 2mg slow IVP over 1 - 2 minutes.
      • May need to be repeated 3 - 4 times.
      • Some recommend up to 10 - 20mg to effectively manage a suspected morphine overdose.
      • Narcan® should be adjusted according to the casualty's respiratory status, NOT the level of consciousness.
    • Naloxone (Narcan®)
      •  How fast does Narcan® work?
      • Immediate positive response
      • (within 2 minutes when given IV)
      • is usually seen when giving Narcan® for morphine poisoning.
      • Duration of action is 1-2 hours.
    • Naloxone (Narcan®)
      • Reassess – Reassess – Reassess
      • But Why?
      • Narcan® effects may wear off earlier than the morphine, permitting the casualty to lapse back into a respiratory depression.
      • Continuously monitor a casualty that has been being given Narcan® to counteract morphine toxicity is crucial.
    • Meloxicam (Mobic)
      • Indications
      • Used for mild/moderate pain in soldiers still able to fight (conscious and lucid)
      • Adverse Reactions
      • Gastrointestinal (GI) issues in higher doses
      • Dosage
      • One 15 mg tablet, by mouth, daily.
    • Acetaminophen (Tylenol)
      • Indications
      • Used for mild/moderate pain in soldiers still able to fight (conscious and lucid)
      • Adverse Reactions
      • Liver damage if given at higher doses for an extended period of time.
      • Dosage
      • Two 650mg bi-layered caplets, by mouth, every 8 hrs
    • Percocet
      • Indications
      • Moderate to severe pain
      • Adverse Reactions
      • Habit forming
      • Contraindicated in person who drinks >3 alcoholic beverages per day OR has a history of alcoholic liver disease.
      • Dosage
      • Must be prescribed by a licensed provider. The MO will determine the proper dosage.
    • Summary
      • By route, give examples of antibiotics?
      • Topical: Neosporin, Bacitracin and Silvadene
      • Oral: Levofloxacin and Septra
      • IV: Ancef, Ertapenum
      • What is the abbreviation for “antibiotic”?
      • ABX
    • Summary
      • Why would a MO direct a person to take an NSAID?
      • Reduce a fever
      • Reduce swelling
      • Reduce pain
      • Are prescriptions required to obtain a NSAID?
      • No – they are available over the counter (OTC)
    • Summary
      • Recall what you learned in the Medication Administration lesson….
      • Are antihistamines recommended in the treatment of an allergic reaction?
      • If yes, which one and what is the dosage?
      • Yes.
      • Diphenhydramine (Benadryl)
      • 25-50 mg IM or IV
    • Summary
      • A Soldier is in pain from wounds sustained while on foot patrol in an Afghan city.
      • The tactical leader plans to evacuate the wounded as soon as it is safe to do so. Enemy are in the area. The Soldier is alert and able to fight.
      • In this situation, what is recommended for the pain?
      • Meloxicam (Mobic) OR acetaminophen (Tylenol).
    • Summary
      • A local Afghan tribal member has arrived at your clinic with his son.
      • After you ensure A-B-C are intact, what would be an appropriate analgesic for this person’s severe pain?
      • Morphine
      • Questions??