Beyond the medications EMTs administer or assist with, they routinely encounter patients taking drugs for chronic conditions. Recognizing these medications, and understanding their purposes and risks, helps the EMT anticipate complications, identify interactions, and communicate effectively with receiving facilities. Cardiovascular medications are especially common in older adults. Beta blockers such as metoprolol and atenolol treat hypertension, angina, and arrhythmias by blocking beta-adrenergic receptors, but in trauma or shock they can blunt the tachycardic response the EMT might otherwise rely on as an early warning sign. ACE inhibitors like lisinopril and enalapril treat hypertension and heart failure by causing vasodilation, and a persistent dry cough, or rarely angioedema, is a classic side effect. Statins such as atorvastatin and simvastatin lower LDL cholesterol to reduce long-term cardiovascular risk but rarely cause acute issues in the field.
Anticoagulants and antiplatelet agents are critical history-taking items because they dramatically increase bleeding risk after trauma. Warfarin, apixaban, and rivaroxaban inhibit parts of the clotting cascade, while clopidogrel and similar drugs block platelet aggregation, often after coronary stent placement. Head trauma in a patient on these medications raises serious concern for intracranial hemorrhage. Diabetic medications pose the opposite risk: insulin and oral hypoglycemics such as metformin or glipizide can cause hypoglycemia when food intake or activity does not match the dose. Diuretics like furosemide (Lasix) reduce fluid volume in heart failure, hypertension, and pulmonary edema, but chronic use may produce hypokalemia and volume depletion.
Respiratory medications include chronic bronchodilator inhalers such as ipratropium and tiotropium, which maintain airway patency in asthma and COPD by relaxing bronchial smooth muscle. Neurologic and psychiatric drugs are also common. Anticonvulsants like phenytoin and levetiracetam prevent seizures, while benzodiazepines such as diazepam and alprazolam treat anxiety, seizures, and insomnia as central nervous system depressants, with significant respiratory depression risk when combined with opioids. Antihistamines such as diphenhydramine block histamine receptors to relieve allergic symptoms, and corticosteroids like prednisone reduce inflammation in asthma, COPD, allergic reactions, and autoimmune disease. Tricyclic antidepressant overdose is a serious toxicologic emergency causing cardiac dysrhythmias and seizures, while antipsychotics such as risperidone and haloperidol manage psychotic symptoms and severe agitation by blocking dopamine receptors. Finally, erectile dysfunction medications such as sildenafil are highly relevant because they potentiate nitrate-induced hypotension, making nitroglycerin administration dangerous if the patient has used them within roughly 24 to 48 hours.