Chapter 9: part 1: pharm & anesthesia

-the study of drugs and their actions

Pharmacology

-a substance used as medicine for the diagnosis, treatment, cure, mitigation, or prevention of disease or a condition

Drugs

- the prevention of disease or a condition.

Prophylaxis

what is the term used to describe the metabolic processing of a drug within the body?

pharmacokinetics

The _____ approves the safety, dosage accuracy and effectiveness after several phases of testing.

FDA

�Drugs in use today come from 5 primary sources: (3 categories)

Natural: Plants, Animals, and Minerals
Chemical: Laboratory synthesis
Biotechnology

: drugs that start with a natural substance that is extracted, purified, and altered by chemical processes.
Vast majority of Drugs are Synthetic or Semisynthetic.
Demerol (synthetic)
Penicillins such as Amoxicillin (semisynthetic)

Semi-synthetic

- manufactured totally from laboratory chemicals

synthetic drugs

: put together.

Synthesized

: scientists will inject a gene into the DNA of a single cell and tell that cell to make a certain protein.

Biotechnology

_____________ can be injected and mixed with Injectable saline. Used to prevent clots - DVT
_____________ will be used with Gelfoam as topical hemostasis

Heparin Thrombin

The process of pharmacokinetics involves : _________ , _________ , __________ , & ___________.

absorption, distribution, biotransformation & excretion

�Occurs at the site of administration
�Passive transport: requires no energy. Most drugs are transported in this manner
�Rate of ____________ affects the final action
There are several factors that affect ____________ (drug preparation, dosage, route of a

absorption

____________ is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles

Vasoconstriction

-Transport of the medication within the body once it enters the circulatory system
-Affected by absorption and cardiovascular function
-Transported to all parts of the body
Can also be hindered by any barriers: blood-brain and placental barriers. Some par

distribution

-Metabolism of the drug (happens mainly in the liver)
-Breakdown products are called metabolites
The main function of the liver in 'drug metabolism' is to break down the drug molecules in preparation for excretion.

Biotransformation

-Effects continue until the drug is bio-transformed and/or _________.
-________ are responsible for filtration of drugs from the blood
-Some may be eliminated via saliva, sweat, exhaled

excreted, Kidneys

-Study of the interaction of drug molecules with the target cells of living tissue.

Pharmacodynamics

can occur when 2 substances are prescribed concurrently, causing a modification of the action of 1 or both drugs.

Drug Interactions

drug potentiates or enhances the effect of another substance. good or bad. Whatever it is, will enhance a reaction in the body.

Agonists

act in combination to produce a stronger effect. Lido w/ Epi, Marcaine w/ Epi (better post-op relief)

Synergistic Agents

: alter some aspect of the action of the original agent. Epinephrine - helps prolong anesthetic action by causing vasoconstriction. (keeps the meds in place longer)

Additive agents

prohibit the agonists from doing it's job. binds to agonist's receptor site, preventing the agonist from binding there and causing its desired effect

Antagonists

�Timing of interactions:
list 3

onset, peak effect, duration

_______ - the period of time required for the effects of the medication to begin

onset

________ - the period of time of the maximum effect(s) of the medication

peak effect

________- the overall period of time when the effects of a medication are demonstrated.

duration

-when/why to take something

Indications

-when something should NOT be taken

Contraindications

-the effects of the substance at the target site.

Actions

-the amount of medication delivered to the patient in order to achieve the optimal therapeutic effect. (depends on several factors)

Dosage

�Drugs are classified according to the:
-__________ action
-________ and body system affected
-______________ action of the drug
-_____________ action of the drug

Principle
Organ
Physiological
Therapeutic

The goal is the ____________ of the illness or the disease to prevent, improve or treat medical conditions

treatment

____________ effect: the concentration or dose of a medication used to produce the desired result without producing harmful effects.

therapeutic

________ effect: An unexpected, undesirable, but tolerable effect of a medication. These can include symptoms such as dry mouth, constipation, diarrhea, dizziness, or drowsiness.

side

_________ effect: An undesirable and potentially harmful effect of a medication that can lead to organ damage or failure. Susceptible organs include the brain, liver, kidney, and cardiovascular system.

adverse

a common adverse reaction is hypersensitivity or ________ reaction, which can range from mild skin irritation or anaphylaxis.

allergic

__________ effect: An undesirable and unacceptable effect of a medication. the effect can include the promotion of growth of cancerous tumors (carcinogens) or the development of birth defects (teratogens)

toxic

______________: A reduction in the effect of a medication given at the same dose over a given period of time. The dosage must be increased in order to receive the desired effect.

tolerance

____________ or __________: A physical or psychological need for the effect of a medication.

addiction
dependence

The most common method used to deliver medication into the body in the OR is ____________: intravenous (IV)

Parenteral

-administration routes-
__________: through the GI tract (oral or rectal)
__________: other than the GI tract (Injection)
__________: applied to the skin or mucous membrane

Enteral
Parenteral
Topical

-Type of preparation or form in which the drug is available will determine its _________ of __________, as well as its pharmacodynamics and pharmacokinetics of the medication.

route of administration

Liquids tend to act more quickly than solids, and gases and vapors tend to act even ________. Drug forms also dictate route of administration.

faster

Main categories of drug preparation: Gas, Liquid, Solid, Semisolid.
Liquids are broken down into: __________, ___________, ___________
Solutions types are: Aqueous, Syrup, Tincture, and Elixir

Solution, Suspension, Emulsion

__________: drug (solute) is dissolved in a liquid (solvent)

solution

__________: solid particles are suspended in a liquid-particles may settle and must be redistributed by shaking prior to administration.

suspension

__________: combination of two liquids that cannot mix-droplets of one liquid are dispersed (suspended) throughout the other.

emulsion

Aqueous: solution prepared with _________.
Syrup: _________ aqueous solution.
Tincture: solution prepared with _________.
Elixir: __________ _________ solution.

water
sweetened
alcohol
sweetened alcohol

�Three different names are assigned to each drug:
1. _________, brand or proprietary name
�Assigned by the manufacturer
2. __________
�Nonproprietary name
�Shortened version of the chemical name
3. __________ name
�Precise chemical composition and molecul

Trade
Generic
Chemical

�_________________ substances
-Drugs with a high potential to cause psychological and/or physical dependence and abuse
: classified according to their level of addictiveness: Class I (high) - Class V (Low)

Controlled

�__________________ medications
-Medications that, if used inappropriately, could cause significant harm to the patient.
: A prescription is a written order of the preparation and dispensing of a medication. Has to be a licensed health care provider to pr

Prescribed

�________-______-_______ (OTC) medications
-Prepared in a dosage that are safe to administer without the direction of a physician. some prescription meds can be sold OTC in lower doses.

Over-the-counter

�_____________ medications
-There are limited studies to determine the safety and effectiveness of these therapies, resulting in a limited understanding. Dietary supplements, herbs, probiotics, vitamins, minerals, etc... Many are NOT FDA approved. These m

Alternative

�Medication orders: PRN, Standing, STAT, Verbal. :
_______ (pro re nata / as needed)
_____________ (given pre-operatively, or listed as standard usage unless otherwise directed)
_______ (given immediately)
____________ (any order given during an operative

PRN
Standing
STAT
Verbal

�Most meds come from the ____________ and sent to the OR, then transferred to the ________ ________.

pharmacy
sterile field

Medication Calculations:
-___________________: ratio of solute to solvent (2 components of a solution) make sure you use "injectable" saline when needed, and "irrigation" saline when needed. (Injecting vs. Irrigating a wound)
Dilute any meds that need to

Concentration
reconstituted

Medication Calculations:
-________: overall amount of medication delivered to the patient.
: we (ST's) state the final amount given to the RN at the end of the case for documentation

Dose

Medication Calculations:
-_______________: medication's use in the surgical setting. ST's are to read the preference card prior to the start of the case to understand the medication you are about to use on your patient. Some medications will have differen

Application

(F - ____) ___/___ = C
(C x ___/___) + ____= F

(F-32)5/9=C
(Cx9/5)+32=F

The freezing point of water is ____ F or ____ C.
The boiling point of water is ____ F or ____ C.
Normal body temperature is ____.__ F or ____ C.
*
9 degrees on the Fahrenheit scale corresponds to 5 degrees on the Celsius scale

32
0
212
100
98.6
37

The primary system used in health care is what?
-Apothecary system: based on weight of a grain of ________

metric system
wheat

Metric Conversion"
1 Kilogram = _______ grams
1 gram = ________ milligrams
1 liter = _______ milliliters

1000
1000
1000

Measurement Equivalents"
1 milliliter = ___ cubic centimeter (cc)
1 fluid ounce = ___ milliliters (mL)
1 kilogram = ____ pounds

1
30
2.2

Metric system:
Length: ________,
Weight: ________,
Volume: ________

meter (m)
gram (g)
liter (l)

The apothecary system (based on the weight of a grain of wheat)
drop = ____
Ounce = ____

gtt
oz

The list of OR medications will be found on the surgeon's preference/procedure card.
ALL medications are verified ________.
The ST and the RN are responsible for ___________, recording the ________, _______ & __________ method that will be used for every

verbally
preparing
name, amount and delivery

The "Six Rights of Medication Administration:
The "right" _________.
The "right" ______.
The "right" ______.
The "right" route of _______________.
The "right" _______ and ____________.
The "right" ________________, including labeling.

patient
drug
dose
administration
time and frequency
documentation

_________- container that requires the top to be broken off to access the contents-usually contains liquid medication. Extra caution must be used when handling glass to ensure the glass does not contaminate the medication upon opening.

ampule

______- plastic or glass container that has a rubber stopper at the top that is held in place with a metal retaining ring-may contain liquid, powder, or compressed powder.

vial

___________ ________- usually contains liquid medication.

preloaded syringe

______- metal or plastic-may contain medication in cream, gel, or ointment forms

tube

DRUGS SHOULD BE VERIFIED ____ TIMES: see page 202-203 for rest of information

3

�Syringes:
-Range from __mL to _____mL
-Most common size is a ___mL
-Three basic parts: barrel, plunger, tip
�The amount of medication in the syringe is measured from the innermost edge of the rubber tip on the end of the plunger.

1-60
10

�Hypodermic needles "Hypos"
�3 basic parts
-Hub (colored plastic end)
-Shaft
-Tip/Point w/ lumen
�The _______ the needle gauge, the
_________ the diameter of the lumen

larger
smaller

When filling up the syringe, you have to make sure the beveled part of the needle is in the liquid (facing _______)

down