Topping Up Patient Medications

Patient safety should always be our top priority when administering medications. As paramedics, it's essential that we become well-versed in the medications we carry, gaining a deep understanding of their pharmacology, pharmacodynamics, and pharmacokinetics. With this knowledge, we can better recognize the risks associated with the drugs in our formulary.

The decision to administer additional medication depends on several factors, most of which are influenced by the patient and the results of a comprehensive assessment and history. To determine whether more medication is necessary, we need to know the dose of the medication that the patient took, the time of the last dose, the reason for its use (current symptoms and clinical presentation), how it's stored, and whether it’s expired. This information, combined with our understanding of the drug, and the ALS PCS (indications, conditions, contraindications, and treatment), allows us to develop a safe care plan.

For instance, if a patient has taken 25 mg of oral diphenhydrAMINE (Benadryl) and is still experiencing noticeable cutaneous reactions, it may be appropriate to administer an additional 25 mg via IM or IV. To avoid an invasive procedure, however, it may also be reasonable to suggest another PO dose of their elixir. Similarly, if a patient has taken a small dose of analgesic, it might be appropriate to adjust the dose according to the guidelines in the ALS PCS.

On the other hand, if a patient recently took dimenhyDRINATE, there may be other medications available that would be more suitable.

Ultimately, your clinical judgment is key. Be sure to document an assessment and documentation of the patient's medical decision-making capacity, and your decision-making process thoroughly (documentation of the medication that the patient has already taken and the rationale for administering or withholding additional doses of the same medication).

Please don't hesitate to consult with a Base Hospital Physician (BHP) if you need additional guidance in making your decision.

Lastly, it’s important to communicate the findings and decisions about the administration of additional doses with the receiving hospital staff to ensure continuity of optimal patient care.

To further support your medication knowledge, here are several resources you can utilize to review the medications you use as a paramedic:

• “An Educational Moment”- contain little vignettes created in MedicLEARN and can be searched by medication name or searching for "an educational moment".
• UpToDate is a very valuable resource. It is an evidence-based clinical resource. It includes a collection of medical information, access to Lexicomp drug monographs and drug-to-drug interactions, and several medical calculators.
• You can also search for medications on the Government of Canada’s Drug Product Database: Access the database - Canada.ca.
• The Compendium of Pharmaceuticals and Specialties is also another option to obtain medication monographs. CPS Subscriptions - English (pharmacists.ca)

These resources can be valuable tools to help ensure you’re making well-informed decisions when it comes to medication administration.