Damn it Jim, I m an EMT not a Doctor. EMS Drug-Drug interactions and how not to be the grim reaper

Transcription

1 Damn it Jim, I m an EMT not a Doctor EMS Drug-Drug interactions and how not to be the grim reaper

2 OBJECTIVES Examine EMS drugs and the interactions they have with other 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.

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

4 EMT 1 Drugs

5 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% O 2 concentration

6 OXYGEN AMIODARONE - MAJOR interaction This interaction between high dose O 2 and amiodarone can cause ARDS Use lowest amount of oxygen needed to maintain oxygenation

7 OXYGEN Fun Facts Oxygen in high concentrations can cause blindness in newborns.

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9 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

10 ASPIRIN ALL OTHER NSAIDS MAJOR interaction Combining aspirin with other NSAIDS increases the risks of GI Bleeding and renal failure

11 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

12 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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14 ACTIVATED CHARCOAL Pregnancy Category N 0 major interactions Hooray! You can give Charcoal without fear!

15 EXCEPT

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17 Oral Glucose Pregnancy Category N 0 Major interactions Again you are safe to give oral glucose

18 EMT 2 Drugs

19 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 opiates and narcan

20 EMT 3 Drugs

21 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

22 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

23 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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25 Lidocaine Pregnancy Category B 20 Major interactions Sodium Nitrite MAJOR interaction Can cause methemoglobinemia Avoid the interaction of these two drugs

26 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

27 Lidocaine AIDS medications MAJOR interaction Increased serum lidocaine Increased chance of seizures Risk vs. Benefits

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29 Atropine Pregnancy Category C 20 MAJOR interactions All preparations of potassium MAJOR interaction GI Bleeds/bezoar Why? Absolute contraindication

30 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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32 Morphine Pregnancy Category C 29 MAJOR interactions Most of these interactions are related to respiratory depression. However

33 Morphine Droperidol MAJOR interaction Prolonged QT syndrome, morphine leads to increased prolongation Weigh the risks vs benefits

34 Morphine Buproprion (Wellbutrin) this drug by itself increases the risk of seizure Morphine increases this risk pretty significantly

35 Morphine FUN FACTS Morphine plus gallstones can cause biliary spasms. Morphine can be given in a neb for terminal COPD or supranuclear palsay

36 NON SCOPE OF PRACTICE DRUGS THAT ARE COMMON EXPANDED SCOPE

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38 ALBUTEROL Pregnancy Category C 20 MAJOR interactions Albuterol Beta Blockers: the effects of both drugs are reduced, use caution Albuterol Fingolimod: prolonged QT syndrome

39 ALBUTEROL Fun facts: Albuterol is used to treat what serious electrolyte imbalance? Hyperkalemia

40 GLUCAGON Pregnancy Category - B 0 MAJOR interactions Glucagon Indomethicin: decreased effects of glucagon

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42 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

43 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

44 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 of abuse? Caffeine! Adenosine is also used in a diagnostic medical procedure Chemical stress test

45 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 antipsychotic med also used to treat Hiccups There is a reversal agent for benzodiazepine, just like narcan for opiates Romazicon

46 REFERENCES Drugs.com authoritative source

47 Thank you very much