Damn it Jim, Im an EMT not a Doctor EMS Drug-Drug interactions and - - PowerPoint PPT Presentation

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Damn it Jim, Im an EMT not a Doctor EMS Drug-Drug interactions and - - PowerPoint PPT Presentation

Sep 21, 2023 297 likes •789 views

Damn it Jim, Im an EMT not a Doctor EMS Drug-Drug interactions and how not to be the grim reaper OBJECTIVES Examine EMS drugs and the interactions they have with other medications. Describe potential negative outcomes of

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“Damn it Jim, I’m an EMT not a Doctor”

EMS Drug-Drug interactions and how not to be the grim reaper

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OBJECTIVES

  • Examine EMS drugs and the interactions they have with
  • ther medications.
  • Describe potential negative outcomes of drug-drug

interactions.

  • Identify clues from a patient's past medical history that

can raise your suspicions of possible drug-drug interactions.

  • Identify unusual antidotes for overdoses and poisons or

atypical uses for certain EMS drugs.

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There is a lot of information out there

  • First off, concerning pregnancy category:

– Category A – Safe for pregnant women – Category B – Safe in animal trials, no human trials – Category C – Unsafe in animals, no human trials – Category D – Unsafe in humans, but benefits might

  • utweigh risks

– Category X – Unsafe in humans and risks outweigh benefits – Category N – Not rated

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EMT 1 Drugs

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OXYGEN

  • Pregnancy Category – N
  • Bleomycin or Blenoxane – MAJOR interaction
  • This interaction increases the toxicity of bleomycin and

can cause fatal ARDS, pneumonitis and pulmonary fibrosis

  • <30% O2 concentration
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OXYGEN

  • AMIODARONE - MAJOR interaction
  • This interaction between high dose O2 and amiodarone

can cause ARDS

  • Use lowest amount of oxygen needed to maintain
  • xygenation
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OXYGEN

  • Fun Facts – Oxygen in high concentrations can cause

blindness in newborns.

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ASPIRIN (ASA, Acetylsalicylic Acid)

  • Pregnancy Category – N
  • 81 Major interactions
  • IBUPROFEN – MAJOR interaction
  • Ibuprofen competes with Aspirin and decreases the

anti-platelet action

  • One study showed that heart patients who were on ASA

but took ibuprofen were more than twice as likely to die

  • Generally avoid mixing these two drugs
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ASPIRIN

  • ALL OTHER NSAIDS – MAJOR interaction
  • Combining aspirin with other NSAIDS increases the risks
  • f GI Bleeding and renal failure
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ASPIRIN

  • ALL OTHER BLOOD THINNERS – MAJOR interaction
  • Aspirin plus blood thinners increases the risk of…

BLEEDING

  • Generally avoid combining – however, weigh the risk of

ASA in the setting of AMI

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ASPIRIN

  • FUN FACTS – Aspirin can cause Reye’s syndrome,

avoid its use in kids with fever

  • 10% of asthmatics are NSAID trigger. You can trigger an

asthma attack with aspirin or other NSAIDs

  • Aspirin OD can cause a bezoar and is on of the drugs for

which Activated Charcoal is still used

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ACTIVATED CHARCOAL

  • Pregnancy Category – N
  • 0 major interactions
  • Hooray! You can give Charcoal without fear!
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EXCEPT

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Oral Glucose

  • Pregnancy Category – N
  • 0 Major interactions
  • Again you are “safe” to give oral glucose
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EMT 2 Drugs

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Narcan

  • Pregnancy Class – C
  • 119 Major Interactions
  • All of the interactions have to do with reversal of opiates,

withdrawal risks etc…

  • There is also a risk of pulmonary edema with both
  • piates and narcan
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EMT 3 Drugs

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Epinephrine

  • Pregnancy Class – C
  • 37 Major interactions
  • All TCAs – MAJOR interaction
  • TCAs markedly increase the pressor effects of

norepinephrine and epinephrine

  • Can cause hypertensive urgency, stroke, etc…
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Epinephrine

  • All non cardioselective beta blocker – MAJOR interaction

– Propanolol, nadolol, carvedilol, labetalol, sotalol, etc…

  • Causes unopposed alpha stimulation and can lead to

hypertensive emergency, stroke

  • Use caution but balance risk vs. need
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Epinephrine

  • Halogenated Anesthetics – MAJOR interaction
  • Makes the heart very irritable and susceptible to

arrhythmia and cardiac death

  • Not that you will see this in the field but hey, good to

know.

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Lidocaine

  • Pregnancy Category – B
  • 20 Major interactions
  • Sodium Nitrite – MAJOR interaction
  • Can cause methemoglobinemia
  • Avoid the interaction of these two drugs
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Lidocaine

  • Buproprion (Wellbutrin) – MAJOR interaction
  • Any medication that reduces seizure threshold
  • Combining these medications can cause seizures
  • Carefully weight the risks of concomitant administration
  • By the way, what is the treatment for Lidocaine OD?
  • Benzodiazepenes
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Lidocaine

  • AIDS medications – MAJOR interaction
  • Increased serum lidocaine
  • Increased chance of seizures
  • Risk vs. Benefits
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Atropine

  • Pregnancy Category – C
  • 20 MAJOR interactions
  • All preparations of potassium – MAJOR interaction GI

Bleeds/bezoar

  • Why?
  • Absolute contraindication
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Atropine

  • Topamax and Zonegran – MAJOR interaction
  • Causes markedly increased temperature, inhibited

sweating and dangerous hyperthermia

  • Use caution when administering atropine to patients with

a seizure history

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Morphine

  • Pregnancy Category – C
  • 29 MAJOR interactions
  • Most of these interactions are related to respiratory

depression.

  • However…
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Morphine

  • Droperidol – MAJOR interaction
  • Prolonged QT syndrome, morphine leads to increased

prolongation

  • Weigh the risks vs benefits
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Morphine

  • Buproprion (Wellbutrin) – this drug by itself increases the

risk of seizure

  • Morphine increases this risk pretty significantly
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Morphine

  • FUN FACTS – Morphine plus gallstones can cause

biliary spasms.

  • Morphine can be given in a neb for terminal COPD or

supranuclear palsay

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NON SCOPE OF PRACTICE DRUGS THAT ARE COMMON EXPANDED SCOPE

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ALBUTEROL

  • Pregnancy Category – C
  • 20 MAJOR interactions
  • Albuterol – Beta Blockers: the effects of both drugs are

reduced, use caution

  • Albuterol – Fingolimod: prolonged QT syndrome
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ALBUTEROL

  • Fun facts: Albuterol is used to treat what serious

electrolyte imbalance?

– Hyperkalemia

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GLUCAGON

  • Pregnancy Category - B
  • 0 MAJOR interactions
  • Glucagon – Indomethicin: decreased effects of glucagon
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LASIX

  • Pregnancy Category – C
  • 26 MAJOR drug interactions
  • Lasix – aminoglycoside antibiotics: can cause hearing

loss

  • Lasix – Amiodarone: dysrhythmia and death (all K+

wasting diuretics)

  • Lasix – Lithium: increased lithium levels and lithium

toxicity

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  • Zofran – Dextromethorphan: Serotonin Syndrome
  • Adenosine – Tegretol: prolonged effects, up to 40 sec
  • Amiodarone – 339 other drugs: QT prolongation Preg D
  • Diphenhydramine – Potassium: just like atropine
  • Diphenhydramine – sodium oxybate: seizure, coma,

death

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Antidotes and Unusual treatments

  • Does anyone know what the treatment/cure for

Antifreeze poisoning is?

– ETOH

  • There is a treatment for acetaminophen OD

– Mucomyst (Acetylcystine)

  • Adenosine is counteracted by what common EMS drug
  • f abuse?

– Caffeine!

  • Adenosine is also used in a diagnostic medical

procedure…

– Chemical stress test

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More antidotes and unusual treatments

  • Glucagon can be used to treat hypoglycemia and…

– Esophageal obstruction

  • What two EMS drugs can be used to treat hyperkalemia

– Albuterol and Glucose (with Insulin)

  • More for your info… Thorazine is a hardcore anti-

psychotic med also used to treat…

– Hiccups

  • There is a reversal agent for benzodiazepine, just like

narcan for opiates…

– Romazicon

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REFERENCES

  • Drugs.com – authoritative source
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Thank you very much