Medication Administration

Question 1

What are the 6 Rights of medication

Answer 1

Right Patient
Right medication
Right Dose
Right Time
Right route
Right documentation

Question 2

What medications can an EMR level administer?

Answer 2

Acetylsalicylic Acid (ASA)
Epinephrine
Ipratropium Bromide (Atrovent)
Naloxone
Nitrous Oxide (Entonox)
Oral Glucose
Salbutamol

Question 3

What is the proper dose for ASA, indications and contraindications

Answer 3

160mg chewed

Suspected ACS (MI)

Contra
hypersensitivity
Active GI bleed
Asthmatic past history sensitivity to ASA/NSAID
Unable to follow commands

Question 4

What is the proper dose for Naloxone, indications and contraindications

Answer 4

.05 mg IV/IO q 2min prn (max 1mg)
.8 IM q 5min prn (max 3.2 mg)
2mg intranasal (1mg/nostril) q3-5min prn (max 4mg)

Peds - .1mg/kg IV/IO single max 2mg single dose q 2min prn (max 10mg
.1mg/kg IM single max 2 mg in divided doses (half required in each of 2 sites) q 2 min prn (max 10mg)
.1mg/kg intranasal to single max 2mg (divided) q 5min prn (max 4mg)

Reversal of respiratory distress due to opioid overdose

Contra
Hypersensitivity

Question 5

What is the proper dose for oral glucose, indications and contraindications

Answer 5

25g PO q5min to max 50g

Hypoglycemia

Contra
Hyperglycemia
Unconscious/unable to follow commands

Question 6

What is the proper dose for salbutamol, indications and contraindications (Ventolin)

Answer 6

2.5-5mg nebulized q 5-15min prn

1 puff MDI (100mcg/puff) with spacer q30-60 seconds to max 30 puffs

Peds - <20kg, 2.5mg nebulized prn max 7.5mg
>20kg, 5mg nebulized prn max 15mg
1 puff with spacer MDI
<20kg q30-60 sec max 15 puffs
>20kg q30-60 sec max 30 puffs

Bronchospasm

Contra-
Hypersensitivity
Tachydysrhythmias

Question 7

What is the proper dose for epinephrine, indications and contraindications (Adrenaline)

Answer 7

.3mg IM (1mg/mL) q 5min prn max .9

Peds - <30kg, .15mg IM q 5min max .45mg
>30kg same as adult

Anaphylaxis

Contra - none when used emergent
Hypersensitivity
Underlying cardiovascular disease

Question 8

What is the proper dose for ipratropium bromide, indications and contraindications (Atrovent)

Answer 8

500mcg (mixed with salbutamol) nebulized (max 1500mcg)
1puff (20mcg/puff) MDI with spacer, q30-60sec prn max 15

Peds- <20kg, 250mcg (mixed with salbutamol) nebulized, max 750mcg >20kg same as adult
Peds MDI with spacer
<20kg q30-60sec max 12 puff
>20kg q30-60sec max 15 puff

Bronchospasm

Contra - hypersensitivity

Question 9

What is the proper dose for nitroglycerin, indications and contraindications (Nitrolingual)

Answer 9

.4mg SL (1spray) q 3-5min prn or until systolic BP less than 100mmHg
.8/hr - patch

Acute coronary Syndrome (ACS)

Contra - Systolic less than 100mmHg
Unable to establish IV access
BP drop 30 points after first dose with hold further (RVI - right ventricle infarct)
Use of phosphodiesterase inhibitors within 24 hours (viagra, cialis,levitra)
12 lead indicated STEMI

Question 10

What is the proper dose for nitrous oxide, indications and contraindications

Answer 10

Self administered prn

Pain from musculoskeletal origin
Burns

Contra- inability for commands
Intoxication (drugs/alcohol)
Head injury (altered LOC)
Thoracic injury (sus pnemothorax)
Abdominal pain and distension sus bowel obstruction