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Down on the PharmSponsored by Community Hospital and
based on the
EMS Village
“Down on the Pharm©” series
Down on the PharmSponsored by Community Hospital and
based on the
EMS Village
“Down on the Pharm©” series
Pharmacy update for EMS
Pharmacy update for EMS
RX List
The 10 most commonly prescribed
drugs
The 10 most commonly prescribed
drugs
As reported by:
Part OnePart One
The number one prescription drug for estrogen replacement
1. Premarin1. Premarin
Indications:
Reduces the risk of osteoporosis and heart disease in post-menopausal
women
Relieves symptoms of menopause
1. Premarin1. Premarin
Side Effects:
The most common side effect is nausea; which usually diminishes the longer therapy continues
May cause women to be more prone to gall bladder disease
PremarinPremarin
PremarinPremarin
Estrogen therapy can affect the effectiveness of two other drugs:
Can decrease the effects of oral anticoagulants (Coumadin)
Can decrease the effects of oral anti-diabetic agents, resulting in increased blood sugar
PremarinPremarinFor more information on estrogen
replacement therapy and Premarin go to:
Wyeth Product Page
http://www.wyeth.com/products/#
or
http://www.premarin.com/index.html
PremarinPremarin
EMS Note:
Be alert for hyperglycemia in patients recently started on
estrogen therapy.
Synthroid® is levothyroxine, a replacement thyroid hormone
About 20 million Americans have some form of thyroid disease
2. Synthroid2. Synthroid
Indications:
Levothyroxine is the drug of choice for thyroid hormone replacement therapy in people who have hypothyroidism
2. Synthroid2. Synthroid
SynthroidSynthroid
Thyroid dysfunction…...
What are the two types?
What causes them?
SynthroidSynthroid
Thyroid dysfunction…...
There are two ways people can become hypothyroid:
They can have an underactive thyroid gland that does not produce enough hormone.
SynthroidSynthroid
Or they may have had an overactive thyroid (hyperthyroidism), and their treatment consisted of surgery or
radioactive iodine to remove or destroy all or part of the gland. The treatment,
therefore, left them hypothyroid, requiring replacement therapy.
SynthroidSynthroid
Hyperthyroidism
May be due to an overactive thyroid gland
Or, if people take too much or too little of their replacement medicine, they can have the same symptoms as if their thyroid was making too much or too little hormone.
Signs of too much Synthroid® include: irritability, insomnia, nervousness,
headache, weight loss, tachycardia, and warm, moist skin.
SynthroidSynthroid
Signs of too little Synthroid® include: fatigue and lethargy, mild weight gain, cold and pale skin, and decreased pulse
and blood pressure
SynthroidSynthroid
SynthroidSynthroid
If someone stops taking the Synthroid® altogether,
they can go into myxedema coma, which is a life-
threatening condition.
SynthroidSynthroid
Prehospital care for myxedema coma includes life-support
measures and rapid transport to definitive care in the ED
What are the signs of myxedema and what is myxedema coma?
SynthroidSynthroid
Patients with myxedema complain of fatigue, lethargy, sleepiness, poor tolerance to cold, mental sluggishness, a tendency to
gain weight, and generalized aches and pains.
SynthroidSynthroid
Their faces often look puffy and waxy.Their skin is dry and coarse; their hair is coarse,
dry, and brittle, and it tends to fall out easily.
These and other symptoms are caused by a low metabolic rate resulting from a
deficiency of the thyroid hormone that stimulates metabolism
SynthroidSynthroid
What happens if myxedema is not
treated?
Myxedema coma, a rare, life-threatening condition, occurs in the progression of
hypothyroidism. It is seen more often in elderly women, and the coma often can be precipitated by infection, medication,
environmental exposure, and other metabolic-related stresses
SynthroidSynthroid
For more information on thyroid disease and myxedema Coma go to:
The Thyroid Newsroomhttp://home.about.com/health/index.htm
SynthroidSynthroid
SynthroidSynthroid
EMS Note:
There is no cardinal sign that a coma is due to hypothyroidism…. prehospital care providers can play a critical role in these patients’ care by getting a careful history from friends or
family members, and examining pill bottles in the home (or area of the call) to see if
Synthroid® is among the patient’s medications
3. Lipitor3. Lipitor
Lipitor is in a class of drugs called HMG-CoA Reductase Inhibitors
The drugs inhibit an enzyme necessary for the body to make cholesterol; therefore,
the body makes less cholesterol, lowering total cholesterol and LDL cholesterol
blood levels.
(atorvastatin)
3. Lipitor3. Lipitor
Indications:
Lipitor is indicated for lowering of serum cholesterol when lifestyle changes are not
achieving success
(atorvastatin)
3. Lipitor3. Lipitor
Actions:
Lipitor (atorvastin) blocks the production of cholesterol in the body
These actions are important in reducing the risk of hardening of the arteries,
which can lead to heart attacks, stroke, and peripheral vascular disease
(atorvastatin)
Atorvastatin is used to reduce the amounts of LDL (bad) cholesterol, total cholesterol, triglycerides (another type of fat), and apolipoprotein B (a protein
needed to make cholesterol)
Atorvastatin is also used to increase the level of HDL (good) cholesterol
LipitorLipitor (atorvastatin)
LipitorLipitor
Adverse Reactions:
Lipitor (as with other lipid-lowering therapies) has been associated with altered
liver function
Alcohol consumption combined with Lipitor may increase the risk…..may lead to
hepatic failure
(atorvastatin)
LipitorLipitor
Adverse Reactions:
Symptoms would include jaundice, dark or orange urine, scleral jaundice, abdominal
distention and pain
(atorvastatin)
LipitorLipitorAnother adverse reaction to Lipitor is myopathy (muscles aches or muscle
weakness)
Myopathy and muscle breakdown may lead to myoglobinurea (the presence of
myoglobin in the urine)
Myoglobin is the molecule that results from muscle tissue breakdown
(atorvastatin)
LipitorLipitor
The myoglobin molecule is large, and if large amounts are present
the patient may develop a condition in which the kidney’s function is impaired and renal
failure may develop
What is the condition?
(atorvastatin)
LipitorLipitor
Rhabdomyolysis….Symptoms may include muscle pain and weakness, brown or
dark red-tinged urine, decreased urine output
(atorvastatin)
LipitorLipitor
EMS Notes:
Trauma patients who are taking Lipitor have a higher risk of developing
rhabdomyolysis…why?
What other conditions may predispose patients to rhabdomyolosis?
(atorvastatin)
Trauma patients are at an increase risk of developing rhabdomyolysis
due to the destruction of muscle cells. When muscle cells are injured,
myoglobin is released.
For more information on Rhabdomyolosis go to:
http://www.mcphu.edu/continuing/cme/medicine/pathogen/introduc.htm
LipitorLipitor (atorvastatin)
Indications:Prilosec (Omeprazole) is used to
treat ulcers and acid reflux.
It acts to inhibit gastric secretion
4. Prilosec4. Prilosec (omeprazole)
We now know that peptic ulcer disease is primarily caused by an
infection with H. pylori, but Prilosec is often prescribed to treat
symptoms and decrease recurrence
4. Prilosec4. Prilosec (omeprazole)
Actions:Unlike the earlier ulcer and GERD drugs such as
ranitidine and cimetidine, which are H2 antagonists (and now available over the
counter), Prilosec® is a proton pump inhibitor. It binds with an enzyme that controls hydrogen
secretion. This blocks the final step in the production of gastric acid. This can inhibit
gastric acid secretion by up to 90%.
4. Prilosec4. Prilosec (omeprazole)
Side effects:
There are few side effects reported with Prilosec
The most common are headache, nausea and abdominal pain
4. Prilosec4. Prilosec (omeprazole)
Prilosec can affect other medications in two ways. One is
an interaction with metabolism in the liver; the other is by changing the pH of the stomach, which may
affect the absorption of some drugs.
4. Prilosec4. Prilosec (omeprazole)
Prilosec can prolong the elimination of diazepam, warfarin and phenytoin…..as well as other drugs that are metabolized by oxidation in the liver
4. Prilosec4. Prilosec (omeprazole)
4. Prilosec4. Prilosec (omeprazole)
EMS Note:
It is important for the EMS provider to be aware of these interactions because increased blood levels of diazepam and phenytoin can decrease the level of consciousness, and increased blood levels of warfarin can cause bleeding.
4. Prilosec4. Prilosec (omeprazole)
For further information on GERD go to:
Gerd Information Resource Centerhttp://www.gerd.com/home.htm
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Hydrocodone is an opioid pain reliever, also known by brand names Vicodin®
and Lortab®, is a synthetic opioid combined with acetaminophen
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Indications:
Prescribed for a wide range of conditions, from acute pain associated with broken bones, to chronic pain associated with
cancer and traumatic injuries
Side effects:
Side effects of hydrocodone are no different from other opioids, and
include: sedation, lightheadedness, lethargy, constipation.
What other drugs fall into the opioid category?
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
What are the signs of an opiate overdose?
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Overdose:
Opiates cause respiratory depression (dose related)
A patient taking opioids will usually have constricted pupils
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
What is the prehospital protocol for opiate overdose?
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Naloxone is the drug of choice for severe respiratory depression
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Remember that the duration of action of naloxone is shorter than that of the opioid, so
sedative and respiratory depression may unexpectedly return when the naloxone wears
off, and the opioid effects take over again.
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
As with any opioid analgesic, there is a great potential for abuse……..
If a patient is taking hydrocodone / APAP, find out why the medication was
prescribed, and how many pills the patient takes every day.
Encourage the patient to be honest with you, because a thorough understanding of a
patient’s actual medication use is critical to proper treatment
both in pre-hospital care and in the ED
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Patients taking opioids for a period of time can develop a physical dependence on the drug. Stopping the drug suddenly
can cause withdrawal
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
Signs and symptoms of opioid withdrawal include: irritability,
sleeplessness, restlessness, tremor, nausea, vomiting, diarrhea, and
abdominal cramps. Peak severity of withdrawal symptoms typically occurs 36 to 72 hours after the last dose of
the opioid
5. Hydrocodone 5. Hydrocodone(Vicodan, Lortab)
EMS Note:
A careful history and scene survey can tip you off quickly if a patient’s decreased LOC is related to the use of opioid analgesics.
6. Albuterol 6. Albuterol
Albuterol is classifies as a beta adrenergic agonist (stimulator)
Albuterol dilates bronchial airways by relaxing the surrounding bronchial muscles
It may be prescribed in an oral form, or as an inhaler
The inhaled form of Albuterol starts working within 15 minutes and can last up to 6 hours
Usual dosing will be 2 puffs every 4 hours
6. Albuterol 6. Albuterol
Adverse Reactions:
Albuterol can cause side effects including palpitations, fast heart rate, elevated blood pressure, tremor, nausea, nervousness, dizziness, sleeplessness, and heart burn.
Throat irritation and nose bleeds can also occur
6. Albuterol 6. Albuterol
Albuterol should be used with caution in patients with coronary heart disease or in patients with cardiac rhythm disturbances
In rare patients, inhaled albuterol can paradoxically precipitate life threatening
bronchospasm
What is a paradoxical effect?
6. Albuterol6. Albuterol
Use of albuterol together with other stimulant medications is discouraged
because of their combined effects on the heart rate, blood pressure, and the potential for causing chest pain in
patients with underlying coronary heart disease.
6. Albuterol 6. Albuterol
Tricyclic antidepressants, such as ELAVIL, should not be used together with
albuterol because of their combined toxicity to the vascular system
6. Albuterol 6. Albuterol
EMS Note:
Albuterol may increase the anxiety level in an already anxious patient.
6. Albuterol 6. Albuterol
Norvasc®, the most commonly prescribed calcium channel blocking
agent, is used to treat high blood pressure or chronic stable angina.
It is prescribed alone or in combination with other drugs for each condition.
7. Norvasc7. Norvasc (amlodipine)
Actions:
By blocking calcium channels, this drug prevents calcium from entering the cardiac and smooth muscle cells.
This action, in turn, causes dilation of peripheral arteries and arterioles, decreases the strength of cardiac contraction, and may decrease heart rate.
7. Norvasc7. Norvasc (amlodipine)
Norvasc® has less effect on the heart’s contraction and rate than
other calcium channel blockers and a greater effect on vessel dilation
7. Norvasc7. Norvasc (amlodipine)
Some other Calcium Channel Blockers include
bepridil diltiazem felodipine flunarizine isradipine nicardipine
nifedipine nimodipine nisoldipine verapamil
7. Norvasc7. Norvasc (amlodipine)
Adverse Effects:
The most common adverse effects are headache, edema flushing, palpitations, and dizziness
Patients may also experience nausea, fatigue, drowsiness and abdominal pain
7. Norvasc7. Norvasc (amlodipine)
7. Norvasc7. Norvasc (amlodipine)
Congestive heart failure may occur as a result of calcium channel blocker therapy
What signs and symptoms might the patient exhibit?
EMS Note:
A sudden stop in therapy (if the patient forgets to get the prescription renewed, or can’t afford to get more pills) can cause an increase in frequency and duration of chest pain.
7. Norvasc7. Norvasc (amlodipine)
For more information about calcium channel blockers got to:
The Rx Listhttp://www.rxlist.com/
7. Norvasc7. Norvasc (amlodipine)
Claritin is an antihistamine
Indication: for control of allergy symptoms such as runny nose, itchy and
watery eyes, itchy palate (roof of the mouth) and sneezing.
8. Claritin8. Claritin (loratadine)
8. Claritin8. Claritin (loratadine)
Claritin is popular due to the lessed risk of drowsiness associated with the drug
9. Trimox9. Trimox (amoxicillin)
Trimox is a brand name of the antibiotic amoxicillin. Amoxicillin is one of the many penicillins, and is used to treat
infections most commonly in the respiratory system, GU tract, skin, soft
tissue, bone, and joints
9. Trimox9. Trimox (amoxicillin)
Amoxicillin is also part of the multi-drug therapy used to treat duodenal ulcers, now believed to be caused by H. pylori
bacteria
9. Trimox9. Trimox (amoxicillin)
Adverse Reactions:
Signs of hypersensitivity include: nausea, vomiting, and an itchy rash (called pruritus), which may or may not progress to the symptoms associated with anaphylaxis
9. Trimox9. Trimox (amoxicillin)
What are the signs of an anaphylactic reaction?
9. Trimox9. Trimox (amoxicillin)
Tachycardia, dyspnea, diaphoresis, wheezing, stridor and circulatory
collapse are the signs of an anaphylactic reaction
What is the treatment for an anaphylactic reaction?
9. Trimox9. Trimox (amoxicillin)
For more information on Trimox got to:
http://www.bms.com/medicines/data/
10. Prozac10. Prozac
Prozac belongs to a category of medications called selective serotonin
re-uptake inhibitors, or SSRIs
10. Prozac10. Prozac
These drugs were originally designed to be used as antidepressants, they are
also prescribed for obsessive-compulsive disorder, panic attacks, and a variety of
other conditions such as anorexia nervosa and fibromyalgia
(fluoxetine)
10. Prozac10. Prozac
Indications:
In 5 and 6 week studies, Prozac was shown to significantly decrease depression, sleep
disorder, and anxiety
It can help treat bulimia, obsessive compulsive disorder and PMDD (pre-
menstraul dysphoric disorder
(fluoxetine)
10. Prozac10. Prozac (fluoxetine)
Side Effects:headache tremor nervousness anxiety difficulty concentrating
nausea diarrhea dry mouth changes in appetite or weightweakness increased sweating
sleepiness insomnia
10. Prozac10. Prozac (fluoxetine)
Contraindications:
Prozac should never be taken with drugs in the MAOI class (Monoamine Oxidase
Inhibitors)
These drugs include: Parnate, Marplan, and Nardil
Serotonergic Syndrome, a life threatening condition, may result…..
10. Prozac10. Prozac (fluoxetine)
Contraindications:Serotonergic Syndrome: May include high
blood pressure, nausea and vomiting, fever, rigidity, rapidly fluctuating vital signs, shock, and mental changes.
10. Prozac10. Prozac (fluoxetine)
MAO Inhibitors were prescribed for treatment of depression
They are rarely prescribed in the advent of the newer antidepressants
such as Prozac
They caused serious side effects
10. Prozac10. Prozac (fluoxetine)
MAO Inhibitors react with:
Foods that have a high tyramine content (most common in foods that are aged or fermented to increase their flavor), such as cheeses; fava or broad bean pods; yeast or meat
extracts; smoked or pickled meat, poultry, or fish; fermented sausage (bologna, pepperoni, salami, summer sausage) or other fermented meat; sauerkraut; or any overripe fruit.
Alcoholic beverages or alcohol-free or reduced-alcohol beer and wine. Large amounts of caffeine-containing food or
beverages such as coffee, tea, cola, or chocolate.
10. Prozac10. Prozac (fluoxetine)
Contraindications:Prozac should not be started until two weeks after stopping therapy with an MAO inhibitor. Because Prozac takes a
long time to be eliminated from the body, patients should wait at least five weeks after stopping Prozac before starting an
MAO inhibitor
10. Prozac10. Prozac (fluoxetine)
Overdose:Prozac® ingested alone as an overdose is generally not life threatening. Common signs and symptoms include drowsiness, tachycardia, nausea, vomiting and tremor. Prozac® ingestion becomes more toxic when combined with alcohol.
10. Prozac10. Prozac (fluoxetine)
Overdose:Fatalities seen with Prozac® overdose are usually associated with ingestion of other drugs that are far more dangerous than the Prozac® itself.
10. Prozac10. Prozac (fluoxetine)
For more info on Prozac and MAOI drugs go to:
http://my.webmd.com/content/article/1680.50554
Post Test and Evaluation
To receive your CEUs you must complete the post test and evaluation. After completion, mail
them, along with a self-addressed, stamped envelope to:
Terri Norris, EMS Coordinatorc/o Emergency Center
2615 E. High St.Springfield, Ohio
45505
Click here to go to the Post Test and Evaluation
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on the Pharm” and to base this program on their copyrighted
articles!
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