Detailed Lesson Plan

Chapter 14

Pharmacology and Medication Administration

200–220 minutes

Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes / Content Outline / Master Teaching Notes
5 / I.Introduction
A.During this lesson, students will learn about assessment and emergency care for a patient whose condition may require administration of a medication.
B.Case Study
  1. Present The Dispatch and Upon Arrival information from the chapter.
  2. Discuss with students how they would proceed.
/ Case Study Discussion
  • How will you know what medications a patient needs?
  • What are the safety precautions to observe when giving medications?

10 / II.Administering Medications
  1. A medication is a drug or other substance used as a remedy for illness
  2. A drug is a chemical substance used to treat or prevent a disease or condition.
  3. Pharmacology is the study of drugs.
  1. When the correct dose of a medication is administered appropriately, the patient’s condition may improve significantly.
  2. When a medication is administered inappropriately, some drugs can cause serious side effects and deterioration in the patient’s condition.
  1. EMT’s responsibility
1.Administer medications under the direct order of a physician only.
2.Administer only medications identified in local protocols.
  1. EMT’s role
  1. Administration implies that the EMT will take all the steps necessary to give the patient a medication.
  2. Assisting means that the EMT will prepare the medication and then hand it to the patient who will take the medication.
/ Discussion Questions
  • What is a drug?
  • What are some examples of drugs?
  • How can these drugs be used to treat or prevent diseases or conditions?
Teaching Tip
Give examples of how a medication can help if used appropriately, such as nitroglycerin used for chest pain; also explain how the same medication can have detrimental effects if used inappropriately (too much, wrong patient, and so on).
Class Activity
Have small groups of students work together to generate a list of drugs they are familiar with.
Critical Thinking Discussion
What are the pros and cons of the many advertisements on television for prescription medications?
Weblink
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access the National Institutes of Health/National Library of Medicine Drug Resource.
30 / III.Medications Commonly Administered by the EMT—Medications Carried on the EMS Unit
  1. Oxygen
  1. Oxygen is an odorless, tasteless, colorless gas.
  2. Makes up 21 percent of ambient air
  3. Indicated for patients with medical or trauma condition and who may be hypoxic
  4. Oral glucose
  1. Glucose is a simple sugar found in blood.
  2. It is the primary energy source for body cells.
  3. If brain cells are deprived of glucose, they die.
  4. Oral glucose is administered to patients with a history of diabetes who are suspected of having low blood glucose levels.
  5. Activated charcoal
  1. Activated charcoal is a fine black powder designed to absorb an ingested poison.
  2. Poison attached to activated charcoal will be carried through the digestive tract and eliminated.
  3. The use of activated charcoal has been questioned and has been removed from many protocols.
  4. Aspirin
  1. Aspirin is administered to a patient who is having chest pains or pain related to a lack of oxygen to the heart.
  2. Aspirin may keep the vessels that deliver blood to the heart from closing shut.
/ Discussion Questions
  • Why is oxygen considered a medication?
  • Under what circumstances might you administer activated charcoal?
  • Why is aspirin used in the prehospital setting?
Critical Thinking Discussion
  • Why are there only a limited number of drugs carried on the EMT’s ambulance?
  • Why must EMTs have a physician’s order to administer medications?
Teaching Tip
Show as many examples as possible of the medications described. Pass the medication containers around the classroom so students can see and touch them.
Weblink
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access a web resourceon medications that can be administered by an EMT.
30 / IV.Medications Commonly Administered by the EMT—Medications Prescribed for the Patient
A.Inhaled bronchodilator
1.Metered-dose inhaler (MDI)
a.Used by a patient with a respiratory disease, such as asthma, emphysema, and chronic bronchitis
b.Patient will experience shortness of breath and signs and symptoms of respiratory difficulty.
c.Only MDIs that contain a beta2-agonist drug can be administered.
d.Delivers medication with one inhalation
2.Small-volume nebulizer (SVN)
a.Uses a different route of delivery than an MDI
b.Place the medication into a specialized chamber and pass oxygen or compressed air through it.
c.The fine vapor that is produced is expelled through a T-tube and into a mouthpiece or mask.
d.Creates a continuous flow of vapor containing medication
B.Nitroglycerin
1.Nitroglycerin is a medication used to treat cardiac patients with diseases of the coronary arteries.
2.This medication is a vasodilator, which dilates the blood vessels.
3.It decreases the demand for oxygen by the heart muscle and increases the supply of oxygenated blood to the heart.
4.The major side effect of this medication is hypotension.
5.It should not be administered to patients taking other medications known to lower blood pressure.
C.Epinephrine
1.Epinephrine is a drug used to treat patients suffering from anaphylaxis.
2.During an anaphylactic reaction, a patient’s blood vessels dilate, the bronchioles constrict, and the capillaries leak fluid.
3.Epinephrine constricts the vessels, dilates the bronchioles, and decreases capillary permeability. / Class Activity
Instead of lecturing on this section, assign each of the drugs listed to a group of students and provide them with several resources in addition to their texts. Each group should take about 15 minutes to research their assigned drug, and then present their findings to the rest of the class. Be sure to emphasize key points and fill in any gaps.
Knowledge Application
Give several examples of patient problems (asthma, chest pain, anaphylactic reaction, or poisoning) and ask students what drug used by EMTs may be indicated for the patient.
Discussion Questions
  • What are the consequences of administering nitroglycerin to a patient who has recently taken a drug for erectile dysfunction?
  • Why is epinephrine used for severe allergic reactions?
Video Clip
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access a video clip describing the actions and use of an epinephrine auto-injector.
15 / V.Medication Names
A.Chemical name
1.Describes the chemical structure of the drug
2.Is usually the first name associated with the drug
B.Generic name
1.Also known as nonproprietary name
2.Shorter than full chemical name
3.Independent of manufacturer
4.Listed in the U.S. Pharmacopoeia
C.Trade name
1.Also known as brand name
2.Assigned when drug is released for commercial distribution
D.Official name
1.Assigned to drugs meeting the requirement of the U.S. Pharmacopoeia or National Formulary
2.Is commonly the generic name followed by the initials U.S.P. or N.F. / Teaching Tip
Give examples of a generic drug name, such as ibuprofen, and several of the trade names it is marketed under.
Discussion Questions
  • What is the generic name of a drug?
  • How is the generic name of a drug different from the official name?
Critical Thinking Discussion
Why must EMTs know both generic and trade names for drugs?
Knowledge Application
List examples of the generic names ofdrugs commonly administered by the EMT and have students match it with trade names, and vice versa.
Class Activity
Give over-the-counter medication containers to small groups of students. Have them search for the generic and trade names and report them to the class.
15 / VI.Routes of Administration
A.The route describes how a medication is given to or taken by a patient.
B.The route controls how fast the medication is absorbed by the body.
C.The EMT prepares the medication in a form that allows the quickest and safest absorption by the body.
  1. Sublingual—Under the tongue
  1. Nitroglycerin tablets
  2. Nitroglycerin spray
  3. Oral—Swallowed
  1. Aspirin
  2. Oral glucose
  3. Activated charcoal
  4. Inhalation—Breathed in by the patient
  1. Oxygen
  2. Metered-dose inhaler
  3. Small-volume nebulizer
  4. Intramuscular injection—Injected into muscle mass
  1. Epinephrine with auto-injector
/ Discussion Questions
  • How does the absorption of drugs administered into the muscle compare with the absorption of drugs administered orally?
  • What is the difference between oral administration and sublingual administration routes?
Teaching Tip
Reinforce learning by naming drugs administered by EMTs and having students state the route by which it is administered.
Class Activity
Pass out small tablet-shaped candies. Tell students not to eat them until you explain the instructions to them. First instruct students as if you were instructing a patient to take an oral medication. Then instruct students as if you were instructing a patient to take a sublingual medication.
Video Clips
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access video clips describing oral glucose administration, nitroglycerin administration, activated charcoal administration, and MDI administration.
Critical Thinking Discussion
How do you think poor perfusion might affect drug absorption?
10 / VII.Medication Forms
A.Medications come in different forms.
B.The form limits administration to one specific route.
C.The form determines the effects of the drug.
D.Common forms of medications administered by the EMT
  1. Compressed powder or tablet
  2. Liquid for injection
  3. Gel
  4. Suspension
  5. Fine powder for inhalation
  6. Small-volume nebulizer
  7. Gas
  8. Spray
/ Discussion Questions
  • What form of medication is used in a small-volume nebulizer?
  • What medication can be administered as a spray?
Teaching Tip
Refer to the equipment and medications you brought in as you discuss each form.
5 / VIII. Essential Medication Information—Indications
A.Indications include the most common uses of the drug in treating a specific condition.
B.Indications are geared toward the relief of signs, symptoms, or specific conditions. / Discussion Question
What is an indication for nitroglycerin?
3 / IX. Essential Medication Information—Contraindications
A.Contraindications are situations in which the drug should not be administered because of potential harm to the patient.
B.In some cases, the drug may not have any benefit to the patient. / Discussion Question
What is a contraindication for nitroglycerin?
3 /
  1. Essential Medication Information—Dose
A.The does indicates how much of the drug should be given to the patient.
B.It is important to distinguish between dosages for adults, children, and infants. / Teaching Tip
Explain the essential information of several drugs to illustrate the concepts in this section.
3 /
  1. Essential Medication Information—Administration
A.Administration refers to the route and form in which the drug is given.
B.The EMT will administer medications sublingually, orally, by inhalation, or by injection. / Critical Thinking Discussion
How does the SAMPLE history assist you with considering whether or not to give a patient a medication?
3 /
  1. Essential Medication Information—Actions
A.The action is the effect the drug has on the body.
B.The therapeutic effect is the intended positive response by the body.
C.The mechanism of action is how the drug works to create its effect on the body. / Knowledge Application
Hand out several over-the-counter medication containers. Have students apply the information from this section to describe the indications, contraindications, dosage, and side effects for the medications.
3 /
  1. Essential Medication Information—Side Effects
A.Side effects are actions that are not desired and that occur in addition to the desired therapeutic effects.
B.Side effects are not allergic reactions.
C.The EMT must be prepared to manage expected and unexpected side effects. / Discussion Question
What is a side effect of nitroglycerin?
5 /
  1. Key Steps in Administering Medications—Obtain an Order from Medical Direction
A.A medical order can be obtained on-line by direct communication with medical direction or off-line through protocols or standing orders.
B.It is important to know and understand local protocols prior to an emergency call.
C.Verify an on-line order by restating the drug, dose, and route.
D.Make judgments as to whether the patient can tolerate the administration of a medication.
5 /
  1. Key Steps in Administering Medications—Select the Proper Medication
A.EMT must ensure that the proper medication is selected.
B.Read the label to check that the medication is consistent with the order.
5 /
  1. Key Steps in Administering Medications—Verify the Patient’s Prescription
A.Verify that the medication is prescribed for the patient.
B.The EMT should not administer medication that is not prescribed for the patient unless ordered to do so by medical direction.
C.If the label is on separate packaging, determine through careful questing if the prescription belongs to the patient. / Discussion Question
Why is it important to verify a patient’s prescription before assisting with medication administration?
5 /
  1. Key Steps in Administering Medications—Check the Expiration Date
A.Check the expiration date of the medication.
B.Do not administer expired medication.
C.Dispose of medications according to your state drug or pharmacy guidelines. / Discussion Question
What things should you be looking for as you inspect a container of medication?
5 /
  1. Key Steps in Administering Medications—Check for Discoloration or Impurities
A.Inspect liquid medications for discoloration or cloudiness.
B.Do not administer cloudy or discolored medication.
C.Discard cloudy or discolored medication appropriately.
5 /
  1. Key Steps in Administering Medications—Verify the Form, Route, and Dose
A.Be sure the proper drug form is used for the route selected.
B.Verify the dose is correct.
C.Match the medication label to the drug order. / Critical Thinking Discussion
How do you think medication errors can occur?
5 /
  1. Key Steps in Administering Medications—Medication Administration: The Five “Rights”
A.Right patient
B.Right medication
C.Right route
D.Right dose
E.Right date (time) / Discussion Question
What are the “rights” of medication administration?
Weblink
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access a web resourceon the “rights” of medication administration.
5 /
  1. Key Steps in Administering Medications—Documentation
A.Document the drug, does, route, and time the medication was administered.
B.Report any changes in the patient’s condition. / Teaching Tip
Demonstrate the steps in the medication administration process, explaining each step and verbalizing your actions.
10 /
  1. Reassessment Following Administration
A.Repeat measurement of vital signs.
B.Assess for any changes in the patient’s condition.
  1. Mental status
  2. Patency of airway
  3. Breathing rate and quality
  4. Pulse rate and quality
  5. Skin color, temperature, and condition
  6. Blood pressure
  7. Change or relief of complaints
  8. Relief of signs and symptoms associated with complaints
  9. Medication side effects
  10. Improvement or deterioration in the patient’s condition
C.Check the adequacy of oxygen administration.
D.Document your reassessment. / Teaching Tip
To review what was learned about the drugs administered by EMTs, list each drug and ask students what changes they should be looking for in the reassessment.
Discussion Question
What are some specific things you should reassess after giving a medication?
Critical Thinking Discussion
Why is it important to document any changes, or lack of changes, in the reassessment?
20 /
  1. Sources of Medication Information
A.AmericanHospital Formulary Service
B.AMA Drug Evaluation
C.Physicians’ Desk Reference (PDR)
D.Package inserts
E.Poison control centers
F.EMS pocket drug reference guide
G.ePocrates for the PDA
H.On-line sources approved by your medical direction / Teaching Tip
Demonstrate the use of several drug reference resources.
Critical Thinking Discussion
How soon do you think sources of drug information are outdated?
Class Activity
Provide small groups of students with drug reference material. Have students look up essential information about the drugs discussed.
10 / XXIV. Follow-Up
  1. Answer student questions.
  2. Case Study Follow-Up
  1. Review the case study from the beginning of the chapter.
  2. Remind students of some of the answers that were given to the discussion questions.
  3. Ask students if they would respond the same way after discussing the chapter material. Follow up with questions to determine why students would or would not change their answers.
  4. Follow-Up Assignments
  5. Review Chapter 14 Summary.
  6. Complete Chapter 14 In Review questions.
  7. Complete Chapter 14 Critical Thinking.
  8. Assessments
  1. Handouts
  2. Chapter 14 quiz
/ Case Study Follow-Up Discussion
  • Why is oxygen the first drug used for this patient?
  • Why is aspirin given to this patient?
  • What side effects should you anticipate from administering nitroglycerin?
Class Activity
Alternatively, assign each question to a group of students and give them several minutes to generate answers to present to the rest of the class for discussion.
Teaching Tips
  • Answers to In Review and Critical Thinking questions are in the appendix to the Instructor’s Wraparound Edition. Advise students to review the questions again as they study the chapter.
  • The Instructor’s Resource Package contains handouts that assess student learning and reinforce important information in each chapter.This can be found under mykit at

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 14 PAGE1