General Pharmacology and Pharmacology for the Soldier Medic

Department of Combat Medic Training

C168W194

General Pharmacology and Pharmacology for the

Soldier Medic

Terminal Learning ObjectiveTerminal Learning Objective

Given a sick call medication,

Identify the class, indications, contraindications of common

medicationIAW Nursing Drug Handbook Chapters

16, 45-47, 55, 59, 60, and 63 & Prehospital Trauma Life Support

Chapter 21.

AntibioticsAntibiotics

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 QuestionAntibiotic - 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.


Which form of antibiotic is most appropriate for: (Be prepared to defend your choices.)

An adult patient with a positive throat culture for Group An adult patient with a positive throat culture for Group A Streptococcus A Streptococcus (AKA strep throat - a bacterial (AKA strep throat - a bacterial

infection)infection)

A Soldier sustains wounds in combat, has A Soldier sustains wounds in combat, has surgery and is currently recovering in ICU.surgery and is currently recovering in ICU.

A small child has a bacterial infection, refusing A small child has a bacterial infection, refusing to swallow pills.to swallow pills.

A 6 year old has an abrasion to her elbow from a A 6 year old has an abrasion to her elbow from a bicycle accident.bicycle accident.


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…Check on your Learning…

What are the advantages and disadvantages of oral antibiotics?

AdvantageOldest method

SafestConvenientEconomical

Easy to Administer

DisadvantagesVomiting

Requires cooperative patient.

Slow absorption rate.

Non-Steroidal Anti - Inflammatory Drugs Non-Steroidal Anti - Inflammatory Drugs

What is easier to say than Non-Steroidal Anti – Inflammatory Drugs ?

NSAID !!!

NSAIDs can do three things. Reduce fever - Antipyretic

Reduce pain - Analgesics

Reduce swelling - Anti-inflammatory

NSAIDSNSAIDS

What NSAIDs have YOU taken and why?

Aspirin (ASA)

Ibuprofen

Naproxen

NSAIDs – Trick QuestionNSAIDs – 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.

NSAIDSNSAIDS

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.

NSAIDSNSAIDS

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)


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 )

HeartburnNauseaLack of AppetiteProlonged Clotting Time

AntihistaminesAntihistamines

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.

AntihistaminesAntihistamines

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.


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

AnalgesicsAnalgesics

Why would someone need an analgesic?

Moderate to severe pain….

Operational and combat injuries

Traumatic amputations

Ballistic injuries

Severe burns

Crush injuries


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


You are responsible for 5 different analgesics:Morphine

Fentanyl

Meloxicam (Mobic)

Acetaminophen (Tylenol)

Percocet

And one narcotic antagonist:Naloxone (Narcan)

MorphineMorphine

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 MorphineIV 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 MorphineIM Morphine

Load the pre-filled cartridge into the injector device.

(usually at a dose of 5 or 10mg)


Select the appropriate site

(uninjured tissue) and

administer the IM injection.


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.

MorphineMorphine

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-InjectorsMorphine Auto-Injectors

The U.S. military utilizes auto-injectors.

One auto-injector usually equals 10mg.

Morphine Auto-InjectorsMorphine Auto-Injectors

Fentanyl (Actiq) Narcotic “Lollipop”Fentanyl (Actiq) Narcotic “Lollipop”

IndicationsModerate to severe pain in casualties who are alert

and conscious.

Patients with known morphine allergies.

Fentanyl “Lollipop”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”Fentanyl “Lollipop”

RouteTransbuccal

Absorbed through the linings of the cheeks.

Dosage

800 microgramsTape the lozenge stick to the patient’s finger. This is

to protect the individual from overdosing.

Reassess every 15 minutes

You are the MedicYou 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®)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.


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.


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.


Reassess – Reassess – ReassessBut 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)Meloxicam (Mobic)

IndicationsUsed for mild/moderate pain in soldiers still able to

fight (conscious and lucid)

Adverse ReactionsGastrointestinal (GI) issues in higher doses

DosageOne 15 mg tablet, by mouth, daily.

Acetaminophen (Tylenol)Acetaminophen (Tylenol)

IndicationsUsed for mild/moderate pain in soldiers still able to

fight (conscious and lucid)

Adverse ReactionsLiver damage if given at higher doses for an extended

period of time.

DosageTwo 650mg bi-layered caplets, by mouth,

every 8 hrs

PercocetPercocet

IndicationsModerate to severe pain

Adverse ReactionsHabit forming

Contraindicated in person who drinks >3 alcoholic beverages per day OR has a history of alcoholic

liver disease.

DosageMust be prescribed by a licensed provider.

The MO will determine the proper dosage.

SummarySummary

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

SummarySummary

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)

SummarySummary

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

SummarySummary

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).

SummarySummary

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??

Education

General Pharmacology and Pharmacology for the Soldier Medic