Working Together In EMS 2002

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HOME MEDICATIONS Bryan Bledsoe, DO, FACEP, EMT-P
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Home Medications

• A patients medications can provide a tremendous
  amount of information regarding the patients
  underlying medical problems.

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Top-Ten Prescriptions in 2001

• 1. Hydrocodone/APAP
• 2. Lipitor
• 3. Premarin
• 4. Synthroid
• 5. Atenolol
• 6. Furosemide
• 7. Prilosec
• 8. Albuterol
• 9. Norvasc
• 10. Alprazolam

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Mrs. Helen McCurdy

• 76 year old female found unresponsive by rural
  postal carrier. No family or friends around.
• Vital Signs
• Blood Pressure 138/90 mmHg
• Heart Rate 102 bpm
• Respirations 10 per minute

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Mrs. Helen McCurdy

• Medications found in cupboard
• Lanoxin
• Lasix
• Vasotec
• Ismo
• K-Dur
• Keflex
• MS-Contin

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Mrs. Helen McCurdy

• Medications found in cupboard
• Lanoxin CHF, atrial fibrillation
• Lasix CHF, HTN
• Vasotec CHF, HTN
• Ismo Angina
• K-Dur Potassium Depletion
• Keflex Infection
• MS-Contin Pain

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Mrs. Helen McCurdy

• Upon evaluation at Sundown ED
• 1. Lacunar stroke due to HTN and AF
• 2. CHF (mild exacerbation)
• 3. Atrial Fibrillation
• 4. Stable angina pectoris
• 5. Moderate HTN (fair control)
• 6. Chronic sciatica due to degenerative disc
  disease
• 7. Recent sinus infection

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Home Medication Packaging

• Shoe Box
• Paper Grocery Bag (Sack)
• K-Mart Plastic Bag
• Wal-Mart Plastic Bag
• Pill holder bought by caring family member which
  sorts pills by time and date (with no labels
  whatsoever)

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What medicines do you take?

• Well, I take a little pink pill in the morning
  and two of the white pills in the evening.
• Oh honeyI dont know. You better call Dr.
  Williams. He keeps up with all of my
  medications.
• Oxy-Contin.and I NEED MORE!!!

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Definitions

• Drugs are chemical agents used in the diagnosis,
  treatment, or prevention of disease.

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Medication Classes

• Analgesics
• Antianginals
• Anxiolytics
• Anticoagulants
• Anticonvulsants
• Antidepressants
• Antidiabetic
• Antihypertensives

• Antipsychotics
• Beta-Blockers
• Bronchodilators
• Calcium Channel Blockers
• Cardiotonics
• Diuretics
• Sedatives/Hypnotics

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Analgesics

• Used to alleviate pain and inflammation
• Narcotics
• Non-Steroidal Anti-Inflammatory Agents
• Non-Narcotic/Non-NSAIDs
• Anti-Migraine Agents

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Narcotic Analgesics

• Used to treat moderate to severe pain
• Morphine
• Codeine
• Vicodin
• Lorcet
• Darvocet
• Lortabs
• Percocet

• Percodan
• Oxy-Contin
• MS Contin
• Stadol NS
• Dilaudid
• Demerol
• Talwin
• Norco
• Fentanyl

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NSAIDs

• Alleviate pain and inflammation
• Motrin
• Toradol
• Naprosyn
• Anaprox
• Celebrex
• Lodine
• Relafen

• Tolectin
• Vioxx
• Voltaren

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Non-Narcotic/Non-NSAID

• Mild-moderate pain
• Acetaminophen
• Ultram
• Topicals

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Anti-Migraine

• Used to treat headache in documented migraineurs
• Inderal
• DHE
• Midrin
• Amerge
• Axert

• Imitrex
• Maxalt
• Zomig

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Anti-Anginals

• Used in the treatment of angina pectoris
• Nitroglycerin
• Ismo
• Isordil
• Cardizem

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Antihypertensives

• Used to decrease blood pressure
• Adrenergic blockers
• ACE Inhibitors
• Angiotensin II Receptor Antagonists
• Beta-Blockers
• Calcium-Channel Blockers
• Diuretics
• Vasodilators
• Combination Agents

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Adrenergic Blockers

• Cause peripheral vasodilation
• Cardura
• Hytrin
• Normodyne

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ACE Inhibitors

• Cause peripheral vasodilation
• Accupril
• Altace
• Captopril
• Lotensin
• Monopril
• Prinivil
• Univasc
• Vasotec
• Zestorectic

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Angiotensin II Receptor Antagonists

• Cause peripheral vosodilation
• Atacand
• Avapro
• Cozaar
• Diovan

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Beta Blockers

• Decrease heart rate and cause peripheral
  vasodilation
• Betapace
• Blocadren
• Corgard
• Inderal
• Sectral
• Tenormin
• Toprol

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Calcium-Channel Blockers

• Cause peripheral vasodilation and slow AV
  conduction
• Adalat
• Cardene
• Cardizem
• DynaCirc
• Isoptin
• Norvasc
• Procardia

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Diuretics

• Cause water excretion decreasing circulating
  volume
• Dyazide
• Maxzide
• Demedex
• Lasix
• Diuril
• Zaroxolyn

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Vasodilators

• Decrease peripheral vasodilation (many agents
  indirectly cause this affect)
• Nitrates
• Calcium Channel Blockers
• ACE Inhibitors

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Combination Agents

• Usually a combination of two antihypertensive
  agents
• Monopril HCT
• Prinizide
• Zestoretic
• Hyzaar

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Antiarrhythmics

• Corrects cardiac dysrhythmias
• Mexitil, Quinidex, Rhythmol, Tambocor
• Betapace, Brevibloc, Inderal
• Cordarone, Corvert
• Cardizem, Isoptin
• Digoxin commonly used to control rate.

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Antilipidemics

• Lowers blood lipids (cholesterol)
• Lopid
• Baycol
• Lescol
• Lipitor
• Mevacor
• Pravachol
• Zocor

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Alzheimers Agents

• Helps manage s/s Alzheimers dosease
• Aricept
• Cognex
• Reminyl

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Anticonvulsants

• Used to prevent seizures
• Nembutal
• Neurontin
• Depakote
• Tegretol
• Dilantin
• Lamictal
• Zaorntin

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Antidiabetic Agents

• Used to lower blood sugar in diabetes
• Insulin
• Glucophage
• Glycet
• Precose
• Diabeta
• Glucotrol

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Antibiotics

• Used to treat infections (primarily bacterial)
• Cephalosporins
• Macrolides
• Penicillins
• Quinolones
• Sulfonamides
• Tetracyclines

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Cephalosporins

• Keflex
• Ceclor
• Cedax
• Ceftin
• Duricef
• Suprax

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Macrolides

• Erythromycin
• Biaxin
• Zithromax

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Penicillins

• Common
• Amoxicillin
• Penn VK
• Beta-Lactam
• Augmentin
• Gorrilacillins
• Unasyn
• Zosyn

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Quinolones

• Cipro
• Floxin
• Levaquin
• Noroxin
• Trovan

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Sulfonamides

• Bactrim
• Septra

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Tetracyclines

• Tetracycline
• Doryx
• Minocin
• Vibramycin

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HIV/AIDS Agents

• Reverse transcriptase inhibitors
• Rescriptor
• Viramune
• Combivir
• Epivir
• Retrovir
• Videx
• Zerit

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HIV/AIDS Agents

• Protease Inhibitors
• Agenerase
• Fortovase
• Norvir
• Viracept

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Anti-Viral Agents

• Inhibit viral growth/reproduction
• Famvir
• Flumadine
• Symmetrel
• Valtrex
• Zovirax

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Anti-Parkinsonian

• Helps minimize the symptoms of Parkinsons
  disease
• Akineton
• Artane
• Benadryl
• Levsin
• Lodosyn
• Mirapex
• Requip
• Sinnemet
• Symmetrel

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Blood Modifiers

• Decrease blood clotting and viscosity
• Coumadin
• Persantine
• Aggrastat
• Plavix
• Ticlid

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Gastrointestinal Agents

• Antacids
• Anticholinergics
• Antidiarrheals
• Antiemetics
• Antispasmodics
• Laxatives
• Anti-Ulcer Agents

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Antacids

• Decrease gastric acid levels
• Calcium antacids
• Magnesium antacids

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Anticholinergics

• Decreases gastric acidity and motility
• Robinul
• Levsin

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Antidiarrheals

• Slow GI motility and increase stool bulk
• Immodium A-D
• Pepto-Bismol

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Antiemetics

• Decreases nausea and vomiting
• Compazine
• Phenergan
• Tigan
• Zofran
• Reglan

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Anti-spasmotics

• Decreases GI motility and spasm
• Donnatal
• Levsin
• Bentyl

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Laxatives

• Evacuates bowels
• Magnesium citrate
• Colace
• Senokot

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Anti-Ulcer Agents

• Decrease gastric acid, promote ulcer healing
• Prilosec
• Prevacid
• Aciphex
• Zantac
• Pepcid

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Hormones

• Substances secreted by ductless glands that
  control other glands and body functions

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Hormones

• How do you make a hormone?
• Dont pay her!

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Hormones

• Estrogens
• Glucocorticoids
• Progesterone
• Thyroid Replacements
• Testosterone

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Estrogens

• Naturally-occurring female hormone used to
  replace natural hormone
• Estrace
• Ogen
• Premarin

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Glucocorticoids

• Used to reduce inflammation and the immune
  response
• Prednisone
• Pediapred
• Prelone
• Medrol
• Decadron
• Cortisone

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Progesterone

• Naturally-occurring female hormone used to
  replace natural hormone
• Provera
• Usually used in combination with estrogen
• OCPs
• Premphase

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Thyroid Hormones

• Used to replace defiicient natural hormone
• Syntrhoid
• Levothroid

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Testosterone

• Used for selected cases of impotence
• Testroderm
• Testred

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Anti-Depressants

• Used to treat depression and other affective
  disorders
• MAOIs
• SSRIs
• TCAs
• Miscellaneous Agents

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Monamine Oxidase Inhibitors

• Increases amount of dopamine by decreasing MAO
• Nardil
• Parnate
• There are many potential problems with patients
  on MAOIs and these should be a red flag.

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Selective Serotonin Reuptake Inhibitors (SSRI)

• Increases brain levels of dopamine
• Celexa
• Paxil
• Prozac
• Zoloft

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Tricyclic Antidepressants (TCAs)

• Increases levels of dopamine in the brain
• Etrafon
• Limbitrol
• Norpramin
• Sinaqual
• Elavil

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Miscellaneous Agents

• Various mechanisms
• Effexor
• Remeron
• Serzone
• Wellbutrin

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Antipsychotics

• Used to treat various psychotic states (i.e.
  schizophrenia)
• Serentil
• Thorazine
• Haldol
• Loxitane
• Moban
• Navane
• Risperdal
• Seroquil

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Psychotic Patients

• Patients with major psychiatric disorders, such
  as schizophrenia, are often non-compliant with
  needed medications. Doctors often prescribe
  long-acting anti-psychotics that can be given
  fortnightly or at even longer intervals (Haldol
  Decanoate)

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Anti-Manic Agents

• Used to control mania in bipolar disorder
• Lithium
• Lithobid
• Eskalith

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Obsessive-Compulsive Disorders

• Used to control obsessive/ritualistic behaviors
• Luvox
• Paxil
• Prozac
• Zoloft

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Antianxiety Agents

• Used to treat anxiety, panic disorders, and
  similar affective disorders
• Valium
• Ativan
• Xanax
• Librium
• Tranxene
• Buspar

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Sedatives/Hypnotics

• Used to sedate or induce sleep
• Commonly-used benzodiazepines
• Restoril
• Halcion
• Dalmane
• Related-Agents
• Ambien
• Sonata

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Respiratory Agents

• Used to decrease bronchospasm, inflammation, and
  to stimulate respirations.
• Beta-Agonists
• Xanthines
• Anti-Inflammatories
• Miscellaneous Agents

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Beta Agonists

• Cause bronchodiation by blocking beta 2
  adrenergic receptors
• Albuterol
• Metaproterenol
• Isoetharine
• Maxair
• Serevent

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Xanthines

• Cause bronchodilation
• Theophylline
• Theo-Dur
• Aminophylline
• Uniphyl

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Anti-Inflammatories

• Decrease inflammation
• Prednisone
• Decadron
• Aerobid
• Azmacort
• Flovent
• Vanceril
• Combivent

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Miscellaneous Agents

• Used to augment other agents.
• Atrovent
• Intal
• Singulair
• Accolate
• Zyflo

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Case Studies

• 42 year old female with altered mental status and
  dyspnea.
• Medications
• Prednisione
• Serevent
• Alupent
• Augmentin

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Case Studies

• 24 year old female with altered mental status and
  fever.
• Medications
• Bactrim
• Retrovir
• Viracept
• Pentamidine

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Case Studies

• 72 year old male with chest pain.
• Medications
• NTG
• ASA
• Prinivil
• Lipitor
• Persantine
• Lanoxin
• Coumadin
• Glucophage

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Case Studies

• 56 year old female with altered mental status
• Lanoxin
• Diabeta
• Vasotec
• Synthroid
• Betapace
• Maxzide
• Ventolin

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• STAY WARM