I



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 |

| |Introduction |Case Study Discussion |

|5 |During this lesson, students will learn about assessment and emergency care for a patient whose condition may |How will you know what medications a patient needs? |

| |require administration of a medication. |What are the safety precautions to observe when giving |

| |Case Study |medications? |

| |Present The Dispatch and Upon Arrival information from the chapter. | |

| |Discuss with students how they would proceed. | |

| |Administering Medications |Discussion Questions |

|10 |A medication is a drug or other substance used as a remedy for illness |What is a drug? |

| |A drug is a chemical substance used to treat or prevent a disease or condition. |What are some examples of drugs? |

| |Pharmacology is the study of drugs. |How can these drugs be used to treat or prevent diseases or |

| |When the correct dose of a medication is administered appropriately, the patient’s condition may improve |conditions? |

| |significantly. | |

| |When a medication is administered inappropriately, some drugs can cause serious side effects and deterioration in |Teaching Tip |

| |the patient’s condition. |Give examples of how a medication can help if used |

| |EMT’s responsibility |appropriately, such as nitroglycerin used for chest pain; also|

| |Administer medications under the direct order of a physician only. |explain how the same medication can have detrimental effects |

| |Administer only medications identified in local protocols. |if used inappropriately (too much, wrong patient, and so on). |

| |EMT’s role | |

| |Administration implies that the EMT will take all the steps necessary to give the patient a medication. |Class Activity |

| |Assisting means that the EMT will prepare the medication and then hand it to the patient who will take the |Have small groups of students work together to generate a list|

| |medication. |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 Emergency Care, |

| | |9th edition to access the National Institutes of |

| | |Health/National Library of Medicine Drug Resource. |

| |Medications Commonly Administered by the EMT— Medications Carried on the EMS Unit | |

|30 |Oxygen | |

| |Oxygen is an odorless, tasteless, colorless gas. |Discussion Questions |

| |Makes up 21 percent of ambient air |Why is oxygen considered a medication? |

| |Indicated for patients with medical or trauma condition and who may be hypoxic |Under what circumstances might you administer activated |

| |Oral glucose |charcoal? |

| |Glucose is a simple sugar found in blood. |Why is aspirin used in the prehospital setting? |

| |It is the primary energy source for body cells. | |

| |If brain cells are deprived of glucose, they die. | |

| |Oral glucose is administered to patients with a history of diabetes who are suspected of having low blood glucose |Critical Thinking Discussion |

| |levels. |Why are there only a limited number of drugs carried on the |

| |Activated charcoal |EMT’s ambulance? |

| |Activated charcoal is a fine black powder designed to absorb an ingested poison. |Why must EMTs have a physician’s order to administer |

| |Poison attached to activated charcoal will be carried through the digestive tract and eliminated. |medications? |

| |The use of activated charcoal has been questioned and has been removed from many protocols. | |

| |Aspirin |Teaching Tip |

| |Aspirin is administered to a patient who is having chest pains or pain related to a lack of oxygen to the heart. |Show as many examples as possible of the medications |

| |Aspirin may keep the vessels that deliver blood to the heart from closing shut. |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 Emergency Care, |

| | |9th edition to access a web resource on medications that can |

| | |be administered by an EMT. |

| |Medications Commonly Administered by the EMT— Medications Prescribed for the Patient |Class Activity |

|30 |Inhaled bronchodilator |Instead of lecturing on this section, assign each of the drugs|

| |Metered-dose inhaler (MDI) |listed to a group of students and provide them with several |

| |Used by a patient with a respiratory disease, such as asthma, emphysema, and chronic bronchitis |resources in addition to their texts. Each group should take |

| |Patient will experience shortness of breath and signs and symptoms of respiratory difficulty. |about 15 minutes to research their assigned drug, and then |

| |Only MDIs that contain a beta2-agonist drug can be administered. |present their findings to the rest of the class. Be sure to |

| |Delivers medication with one inhalation |emphasize key points and fill in any gaps. |

| |Small-volume nebulizer (SVN) | |

| |Uses a different route of delivery than an MDI |Knowledge Application |

| |Place the medication into a specialized chamber and pass oxygen or compressed air through it. |Give several examples of patient problems (asthma, chest pain,|

| |The fine vapor that is produced is expelled through a T-tube and into a mouthpiece or mask. |anaphylactic reaction, or poisoning) and ask students what |

| |Creates a continuous flow of vapor containing medication |drug used by EMTs may be indicated for the patient. |

| |Nitroglycerin | |

| |Nitroglycerin is a medication used to treat cardiac patients with diseases of the coronary arteries. |Discussion Questions |

| |This medication is a vasodilator, which dilates the blood vessels. |What are the consequences of administering nitroglycerin to a |

| |It decreases the demand for oxygen by the heart muscle and increases the supply of oxygenated blood to the heart. |patient who has recently taken a drug for erectile |

| |The major side effect of this medication is hypotension. |dysfunction? |

| |It should not be administered to patients taking other medications known to lower blood pressure. |Why is epinephrine used for severe allergic reactions? |

| |Epinephrine | |

| |Epinephrine is a drug used to treat patients suffering from anaphylaxis. |Video Clip |

| |During an anaphylactic reaction, a patient’s blood vessels dilate, the bronchioles constrict, and the capillaries |Go to |

| |leak fluid. |and click on the mykit link for Prehospital Emergency Care, |

| |Epinephrine constricts the vessels, dilates the bronchioles, and decreases capillary permeability. |9th edition to access a video clip describing the actions and |

| | |use of an epinephrine auto-injector. |

| |Medication Names |Teaching Tip |

|15 |Chemical name |Give examples of a generic drug name, such as ibuprofen, and |

| |Describes the chemical structure of the drug |several of the trade names it is marketed under. |

| |Is usually the first name associated with the drug | |

| |Generic name |Discussion Questions |

| |Also known as nonproprietary name |What is the generic name of a drug? |

| |Shorter than full chemical name |How is the generic name of a drug different from the official |

| |Independent of manufacturer |name? |

| |Listed in the U.S. Pharmacopoeia | |

| |Trade name |Critical Thinking Discussion |

| |Also known as brand name |Why must EMTs know both generic and trade names for drugs? |

| |Assigned when drug is released for commercial distribution | |

| |Official name |Knowledge Application |

| |Assigned to drugs meeting the requirement of the U.S. Pharmacopoeia or National Formulary |List examples of the generic names of drugs commonly |

| |Is commonly the generic name followed by the initials U.S.P. or N.F. |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. |

| | | |

| |Routes of Administration |Discussion Questions |

|15 |The route describes how a medication is given to or taken by a patient. |How does the absorption of drugs administered into the muscle |

| |The route controls how fast the medication is absorbed by the body. |compare with the absorption of drugs administered orally? |

| |The EMT prepares the medication in a form that allows the quickest and safest absorption by the body. |What is the difference between oral administration and |

| |Sublingual—Under the tongue |sublingual administration routes? |

| |Nitroglycerin tablets | |

| |Nitroglycerin spray |Teaching Tip |

| |Oral—Swallowed |Reinforce learning by naming drugs administered by EMTs and |

| |Aspirin |having students state the route by which it is administered. |

| |Oral glucose | |

| |Activated charcoal |Class Activity |

| |Inhalation—Breathed in by the patient |Pass out small tablet-shaped candies. Tell students not to eat|

| |Oxygen |them until you explain the instructions to them. First |

| |Metered-dose inhaler |instruct students as if you were instructing a patient to take|

| |Small-volume nebulizer |an oral medication. Then instruct students as if you were |

| |Intramuscular injection—Injected into muscle mass |instructing a patient to take a sublingual medication. |

| |Epinephrine with auto-injector | |

| | |Video Clips |

| | |Go to |

| | |and click on the mykit link for Prehospital Emergency Care, |

| | |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? |

| |Medication Forms |Discussion Questions |

|10 |Medications come in different forms. |What form of medication is used in a small-volume nebulizer? |

| |The form limits administration to one specific route. |What medication can be administered as a spray? |

| |The form determines the effects of the drug. | |

| |Common forms of medications administered by the EMT |Teaching Tip |

| |Compressed powder or tablet |Refer to the equipment and medications you brought in as you |

| |Liquid for injection |discuss each form. |

| |Gel | |

| |Suspension | |

| |Fine powder for inhalation | |

| |Small-volume nebulizer | |

| |Gas | |

| |Spray | |

| | Essential Medication Information—Indications |Discussion Question |

|5 |Indications include the most common uses of the drug in treating a specific condition. |What is an indication for nitroglycerin? |

| |Indications are geared toward the relief of signs, symptoms, or specific conditions. | |

| |IX. Essential Medication Information—Contraindications |Discussion Question |

|3 |Contraindications are situations in which the drug should not be administered because of potential harm to the |What is a contraindication for nitroglycerin? |

| |patient. | |

| |In some cases, the drug may not have any benefit to the patient. | |

| | Essential Medication Information—Dose |Teaching Tip |

|3 |The does indicates how much of the drug should be given to the patient. |Explain the essential information of several drugs to |

| |It is important to distinguish between dosages for adults, children, and infants. |illustrate the concepts in this section. |

| |Essential Medication Information—Administration |Critical Thinking Discussion |

|3 |Administration refers to the route and form in which the drug is given. |How does the SAMPLE history assist you with considering |

| |The EMT will administer medications sublingually, orally, by inhalation, or by injection. |whether or not to give a patient a medication? |

| |Essential Medication Information—Actions |Knowledge Application |

|3 |The action is the effect the drug has on the body. |Hand out several over-the-counter medication containers. Have |

| |The therapeutic effect is the intended positive response by the body. |students apply the information from this section to describe |

| |The mechanism of action is how the drug works to create its effect on the body. |the indications, contraindications, dosage, and side effects |

| | |for the medications. |

| |Essential Medication Information—Side Effects |Discussion Question |

|3 |Side effects are actions that are not desired and that occur in addition to the desired therapeutic effects. |What is a side effect of nitroglycerin? |

| |Side effects are not allergic reactions. | |

| |The EMT must be prepared to manage expected and unexpected side effects. | |

| |Key Steps in Administering Medications—Obtain an Order from Medical Direction | |

|5 |A medical order can be obtained on-line by direct communication with medical direction or off-line through | |

| |protocols or standing orders. | |

| |It is important to know and understand local protocols prior to an emergency call. | |

| |Verify an on-line order by restating the drug, dose, and route. | |

| |Make judgments as to whether the patient can tolerate the administration of a medication. | |

| |Key Steps in Administering Medications—Select the Proper Medication | |

|5 |EMT must ensure that the proper medication is selected. | |

| |Read the label to check that the medication is consistent with the order. | |

| |Key Steps in Administering Medications—Verify the Patient’s Prescription |Discussion Question |

|5 |Verify that the medication is prescribed for the patient. |Why is it important to verify a patient’s prescription before |

| |The EMT should not administer medication that is not prescribed for the patient unless ordered to do so by medical |assisting with medication administration? |

| |direction. | |

| |If the label is on separate packaging, determine through careful questing if the prescription belongs to the | |

| |patient. | |

| |Key Steps in Administering Medications—Check the Expiration Date |Discussion Question |

|5 |Check the expiration date of the medication. |What things should you be looking for as you inspect a |

| |Do not administer expired medication. |container of medication? |

| |Dispose of medications according to your state drug or pharmacy guidelines. | |

| |Key Steps in Administering Medications—Check for Discoloration or Impurities | |

|5 |Inspect liquid medications for discoloration or cloudiness. | |

| |Do not administer cloudy or discolored medication. | |

| |Discard cloudy or discolored medication appropriately. | |

| |Key Steps in Administering Medications—Verify the Form, Route, and Dose |Critical Thinking Discussion |

|5 |Be sure the proper drug form is used for the route selected. |How do you think medication errors can occur? |

| |Verify the dose is correct. | |

| |Match the medication label to the drug order. | |

| |Key Steps in Administering Medications—Medication Administration: The Five “Rights” |Discussion Question |

|5 |Right patient |What are the “rights” of medication administration? |

| |Right medication | |

| |Right route |Weblink |

| |Right dose |Go to |

| |Right date (time) |and click on the mykit link for Prehospital Emergency Care, |

| | |9th edition to access a web resource on the “rights” of |

| | |medication administration. |

| |Key Steps in Administering Medications—Documentation |Teaching Tip |

|5 |Document the drug, does, route, and time the medication was administered. |Demonstrate the steps in the medication administration |

| |Report any changes in the patient’s condition. |process, explaining each step and verbalizing your actions. |

| |Reassessment Following Administration |Teaching Tip |

|10 |Repeat measurement of vital signs. |To review what was learned about the drugs administered by |

| |Assess for any changes in the patient’s condition. |EMTs, list each drug and ask students what changes they should|

| |Mental status |be looking for in the reassessment. |

| |Patency of airway | |

| |Breathing rate and quality |Discussion Question |

| |Pulse rate and quality |What are some specific things you should reassess after giving|

| |Skin color, temperature, and condition |a medication? |

| |Blood pressure | |

| |Change or relief of complaints |Critical Thinking Discussion |

| |Relief of signs and symptoms associated with complaints |Why is it important to document any changes, or lack of |

| |Medication side effects |changes, in the reassessment? |

| |Improvement or deterioration in the patient’s condition | |

| |Check the adequacy of oxygen administration. | |

| |Document your reassessment. | |

| |Sources of Medication Information |Teaching Tip |

|20 |American Hospital Formulary Service |Demonstrate the use of several drug reference resources. |

| |AMA Drug Evaluation | |

| |Physicians’ Desk Reference (PDR) |Critical Thinking Discussion |

| |Package inserts |How soon do you think sources of drug information are |

| |Poison control centers |outdated? |

| |EMS pocket drug reference guide | |

| |ePocrates for the PDA |Class Activity |

| |On-line sources approved by your medical direction |Provide small groups of students with drug reference material.|

| | |Have students look up essential information about the drugs |

| | |discussed. |

| |XXIV. Follow-Up |Case Study Follow-Up Discussion |

|10 |Answer student questions. |Why is oxygen the first drug used for this patient? |

| |Case Study Follow-Up |Why is aspirin given to this patient? |

| |Review the case study from the beginning of the chapter. |What side effects should you anticipate from administering |

| |Remind students of some of the answers that were given to the discussion questions. |nitroglycerin? |

| |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. |Class Activity |

| |Follow-Up Assignments |Alternatively, assign each question to a group of students and|

| |Review Chapter 14 Summary. |give them several minutes to generate answers to present to |

| |Complete Chapter 14 In Review questions. |the rest of the class for discussion. |

| |Complete Chapter 14 Critical Thinking. | |

| |Assessments |Teaching Tips |

| |Handouts |Answers to In Review and Critical Thinking questions are in |

| |Chapter 14 quiz |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 |

| | |. |

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MASTER TEACHING NOTES

• Case Study Discussion

• Teaching Tips

• Discussion Questions

• Class Activities

• Media Links

• Knowledge Application

• Critical Thinking Discussion

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