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According to firetender, paramedics need to learn more about pharmacology.
Want to be an effective Paramedic? Become a Pharmacist!
I agree.
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We do not begin to understand enough about the drugs we give to patients. We assume that the drugs we give have only one, or maybe two, effects on the patient. Therefore we feel comfortable giving a series of drugs to patients without much reassessment – maybe without any reassessment.
The point that firetender is making is a bit different. He is not referring to the way we push enough syringes full of medication that we need to worry about fluid overload. He is referring to the half dozen to two dozen medications that many patients seem to be taking.
How many times do we consider the possible drug interactions when we give a drug?
What about when we routinely follow that drug with another drug?
Suppose the patient has a fentanyl patch. How much fentanyl, or morphine, is appropriate to give to the patient? How much is too much? How much is such a low dose that it only acts as a placebo?
What about chest pain? Aspirin has some unpleasant side effects. There are many reasons to use caution when giving aspirin, but what does that mean? If aspiring is the only drug we have that has been shown to improve outcomes for heart attack patients, should we withhold it from patients who have had bleeding ulcers, recent surgery, henophilia, and others.
Oops. Hemophilia is not specifically listed, but hemophilia, intracranial bleeding problems, and an anaphylactic response to aspirin are about all I would want to withhold aspirin for. Even then, I will be trying to find out more details, so that I can give a more complete picture of the possible problems to the ED staff.
So you would kill the patient with a triple A, or any aortic aneurysm?
Not really. Giving aspirin does not cause bleeding, but does interfere with the body’s response to bleeding. Clotting becomes a problem, but nowhere near as bad as with clopidogrel (Plavix), which many patients take as a part of their regularly prescribed medications. We have avoided giving opioids to patients with abdominal pain because surgeons tend to whine about how much better their assessment skills are when the patient is writhing in pain. This is not supported by any research, but is preached by too many.[1]
If we really want to make surgeons cranky, we only need to tell them that the patient is taking clopidogrel. Clopidogrel does not guarantee problems, but it does make it much more difficult to control bleeding, which is important for a surgeon. Just how dangerous is clopidogrel?
How should we treat patients who are taking clopidogrel?
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Footnotes:
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[1] Analgesia in patients with acute abdominal pain.
Manterola C, Vial M, Moraga J, Astudillo P.
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD005660. Review.
PMID: 21249672 [PubMed - indexed for MEDLINE]
AAP is Acute Abdominal Pain –
AUTHORS’ CONCLUSIONS:
The use of opioid analgesics in the therapeutic diagnosis of patients with AAP does not increase the risk of diagnosis error or the risk of error in making decisions regarding treatment.
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You make a lot of good points here. I think we are all familiar with caring for patients on a daily basis who have 20 or 40 regularly prescribed medications (not hyperbole!). There is currently no way of knowing how all those different combinations of drugs affect the body.
Also, when new medications are put on the market, even less information is available about possible interactions. For example, a lot of physicians seem to have jumped on the Pradaxa (dabigatran) bandwagon for patients with a-fib. Routine testing of coagulation isn’t done with patients on Pradaxa, which is advertised as an advantage of the drug, but also means that there is no way to quantify the effect the drug is having on the patient … until something bad happens. Of the 19 other medications that patient is taking, how many of them may possibly potentiate or attenuate the effect of the drug? Or have effects on the patient’s body that may make it more of less effective? Is there any way to know?