Ch. 9 Surgical Pharmacology

Conversion of temperature

(F-32) 5/9 = C, (C x 9/5) +32 = F

1oz =

30mL

98.6 F =

37 C

Pseudocholinesterase Deficiency Syndrome

A genetically transmitted disease trait that decreases the amount of actetylcholinesterase available in the neuromuscular junction to break down acetylcholine during muscular stimulation

Indication

A listing of the medical conditions that the medication is known to treat

Addiction

A physical or psychological dependency on the effect of medication

Solution

A solute that is dissolved in a solvent

Elixir

A solution that is prepared as a sweetened alcohol solution

Syrup

A solution that is prepared as a sweetened water solution

Synergistic Agents

Act in combination to produce a stronger or more powerful effect than would be demonstrated if each agent was administered individually

Regional Anesthesia

Administration of an anesthetic along a major nerve tract by the anesthesia care provider

Sedative

Agent produces a soothing or quieting effect but does not cause the person to sleep

General Anesthesia

An alteration in patient's perception of their environment through alterations in their level of consciousness

Toxic Effect

An undesirable & unacceptable effect of a medication, can cause cancerous tumor or birth defects

Lidocaine

Antiarrhythmia, & anesthetic

Bactracin

Antibiotic

Medications used in Orthopedic Surgery

Antibiotics, hemostatic agents, & steroids

Medications used in Neurosurgery

Antibiotics, heparinized saline solution, contrast media, topical papaverine HCL, & lidocaine HCL

Atropine

Anticholinergic or antimuscarinic - decrease mucous secretion or treat bradycardia

Heparin

Anticoagulant use for vascular cases Generic name: Heparin Sodium Classification: Anticoagulants

Contrast Media

Appears radiopapaque on X-ray

Induced Hypothermia

Artificial, deliberate lowering of the body's core temperature below normal limits

Absorbable Gelatin Sponge

Available in powder form or foam pad, when it is placed fibrin is deposited

Antagonists

Binds to the agonist's receptor site, preventing the agonist from binding there & causing the desired effect

The organ that is responsible for the metabolism (breaking down) of drugs in a process known as ____ is the liver

Biotransformation

Antimuscarinic Agents

Block the cholinergic effect of certain drugs or stimulation of the parasympathetic nervous system

Anticholinergic or antimuscarinic

Blocks parasympathetic impulses

There are 2 barriers, known as the ____ & ____ barriers, found within the body that can prevent certain medications from passing through to the tissue on the other side

Blood-brain & placental

Drug route: Topical

Buccal, Sublingual, Instillation, Inhalation

Silver nitrate

Caustic pencil or swab stick for cervical or nasal bleeding

Avitene

Collagen kept dry prior to placement

Dye

Colors or marks tissue

Contraindication

Conditions or circumstances under which a medication should not be used

Miotic

Constricts pupil

If the patient enters the OR bleeding, what is the goal of the surgical team?

Control bleeding & achieve hemostasis

Silver Nitrate

Control cervix or nasal bleeding; applied in a stick form as a caustic pencil or solution

Intravenous Agents

Delivered directly into the bloodstream act quickly

Agent Inhalation

Delivery of gases across the lung's alveolar membrane where the agent enters the vascular system & is transported to the brain where it is able to cross the blood-brain barrier

Controlled Substances Act of 1970

Designates certain drugs as controlled substances, classifying these substances according to their level of addictiveness & therapeutic potential

Cycloplegic

Dilates pupil

What is the treatment of Malignant Hypothermia?

Discontinuation of anesthesia administration & oxygenation of the patient with 100% oxygen , a nontriggering anesthetic agent may be given

Fibrinolytic

Dissolves clots or thrombus - enzyme

Primary transportation system of the cardiovascular system is responsible for the ____ of medication to the target organ or tissue

Distribution

What are the 3 main theories that have been developed to explain drug action?

Drug-receptor interaction, drug-enzyme reaction, & nonspecific drug reaction

Controlled Substances

Drugs with a high potential to cause psychological &/or physical dependence & abuse

Tolerance

Effect of the medication given over a period of time is reduced

Cation

Energy source for drugs to carry the drug from an area of lower concentration to an area of higher concentration

Hemostatic

Enhances formation of clot or thrombus

Side Effect

Expected, undesirable, but tolerable effect of medication

Nitrous Oxide

Gas anesthetic; may increase ear pressure, may contribute to postoperative nausea & vomiting (PONV)

Gelfoam

Gelatin powder or pad that deposits fibrin Generic name: absorbable gel-atin sponge Classification: hemostatic agent

Use of the ____ is advocated int he healthcare setting the avoid confusion between medication

Generic name

Tracium

Generic name: Atrcurium Classification: Nondepolarizing- Neuromuscullar Blocker

Marcaine

Generic name: Bupivicaine HCL Classification: Anesthetic Agent/ Nerve Blocker

Ancef

Generic name: Cefazolin Classification: Antibiotic

Tagmet

Generic name: Cimetidine Classification: Histamine 2 Bllocker

Dantrium

Generic name: Dantrolene Sodoum Classification: MH Antagonist

Decadron

Generic name: Dexamethasone Classification: Steroids

Renografin, Omipaque, or Isovue

Generic name: Diatrizioc Acid Classification: Contrast Agent

Valium

Generic name: Diazepam Classification: Antianxiety- Sedative/ tranquilizer

Benadryl

Generic name: Diphenhydramine Classification: Antihistamine

Adrenalin

Generic name: Epinephrine Classification: Adrenergics

Sublimaze

Generic name: Fentanyl Citrate Classification: Analgesics/ Opiate/ Narcotic

Lasix

Generic name: Furosemide Classification: Diuretic

Amphadse (formerlyWydase )

Generic name: Hyaluronidase Classification: Anesthetic agent

Solu-Cortef

Generic name: Hydrocortisone Sodium Succinate Classification: Steroids

Humulin

Generic name: Insulin Human Recombinant Classification: Insulin

Kantrex

Generic name: Kanamycin Classification: Antibiotic

Xylocaine hydrochloride

Generic name: Lidocaine injection Classification: Local Anesthetic

Demerol

Generic name: Meperidine Hydrochloride Classification: Analgesics

Flagyl

Generic name: Metronidazole Classification: Antimicrobial

Versed

Generic name: Midazolum Hydrochloride Classification: Sedative/ tranquilizer

Narcan

Generic name: Naloxone Hydrochloride Classification: Narcotic

Surgicel or Oxycel

Generic name: Oxidized Cellulose Polymer Classification: Hemostatic

Pitocin

Generic name: Oxytocin Classification: Oxytocic

Papaverine

Generic name: Papverine Hydrochloride Classification: Anesthetic

Silavdene

Generic name: Silver Suladiazine Classification: Sulfomamides

Anectine

Generic name: Suxamethonium Chloride Classification: Depolarizing- Neuromuscular Blocker

Pentothal Sodium

Generic name: Thiopental Sodium Classification: Induction Agent

Toradol

Generic name: Tromethamine Classification: NSAID agent

Coumadin

Generic name: Warfarin Sodium Classification: Vitamin K Antagonist

Prophylaxis

Given 1hour prior to incision to prevent SSI

Mitigation

Given to reduce the force or intensity of a disease or condition

Additive

Given with a medication to alter some aspect of the medication's action

Volatile Agents

Group of liquids whose potent vapors, when inhaled, produce general anesthesia through CNS depression & decreased electroencephalogram activity

Thrombin

Hemostatic agent, bovine enzyme that resulted from the activation of prothombin, applied directly to to site, never given via IV

Medications used in Cardiovascular Surgery

Heparinized saline solution, heparin, contrast media, topical papaverine HCL, lidocaine HCL, & oxidized cellulose

Epinephrine

Hormone vasoconstrictor, mixed with Gelfoam, soaked sponges, or with a local anesthetic

Prescribed Medications

If used inappropriately, could cause significant harm to the patient

Amino Ester Group

Include Cocaine HCL, Procaine HCL, & Tetracaine HCL

Diuretic

Increase urine output or treat edema

Malignant Hypothermia (MH)

Increased production of carbon dioxide, tachycardia, muscle rigidity, & finally a rapid increase in core body temperature

Vasoconstrictor

Increases blood pressure

Spinal Block

Injection of an anesthetic agent into the cerebrospinal fluid; additives to the anesthetic solution may prolong the action of the action

Nerve Plexus Block

Injection of an anesthetic solution in an area of a major nerve plexus or at the base of a structure

Drug route: Parenteral

Intradermal, Subcutaneous, Intramuscular, Intravenous, Intra-articular, Intrathecal, Intracardiac

Induction Phase of General Anesthesia

Involves altering the patient's level of consciousness from the conscious state to the unconscious state. Environmental noise should be kept to a minimum during this phase.

Induced Hypotension

Involves the controlled decrease of blood pressure during anesthetic administration

Microfilbillar Collagen

It must be kept dry or it becomes extremely sticky

Medications must be excreted primarily through the ____, although some medication excretion can occur fecally or via sweat, saliva, exhalation, or breast milk

Kidneys

Suspension

Liquid drug form, a mixture of 2 liquids whereby the droplets of 1 liquid are suspended throughout another

Emulsion

Liquid drug form, has solid particles suspended in a liquid

Nerve Conduction Blockade

Local or regional anesthesia, use of pharmaceutical agents to prevent the transmission of sensory nerve impulses

How are drugs labeled on the sterile field?

Medication name & concentration

Induction Agents

Medications used to permit a rapid transition from a state of consciousness to unconsciousness, do not provide pain relief or motor-impulse blockade

Medications used in Ophthalmic Surgery

Mydriatics, cycloplegic, miotic, viscosurgical, hyperosmotic, anti-inflammatory agents, & antibiotics

What medical information is the surgical technologist responsible for?

Name, classification, actions, indications, uses in the surgical setting & dosage for the use in the surgical setting

Amino Amide Group

Nerve Conduction Blockade that is metabolized in the liver & excreted by the kidneys

Emergence Phase of General Anesthesia

Occurs as the surgical intervention is being completed. The goal is to have the patient awake as possible at the ends of surgery

Agonists

Occurs when a drug potentiates or enhances the effect of another substance

Drug route: Enteral

Oral, rectal

Mannitol

Osmotic diuretic

Blood clots rapidly form in the presence of what?

Oxidized Cellulose

Surgical or Nu-knit

Oxidized cellulose removed from vessels/nerves prior to closure

Medications used in Obstetric & Gynecological Surgery

Oxytocics, vasopressin & immunoglobin

Mydriatic

Paralyzes the ciliary muscle of eye

What factors affect the dosage of a medication?

Patient's age, weight, & overall medical condition; the delivery route of the medication & recommended maximum dosage

Recovery Phase of General Anesthesia

Period of time during which the patient returns to the optimum level of consciousness & well-being

Onset

Period of time required for the effect of a drug to occur

Peak Effect

Period of time when the maximum effect of a medication occurs

Over-the-Counter Medications

Pharmacologic agents that are prepared in a dosage that are safe to administer without the direction of a physician

Topical Anesthesia

Placement of a nerve conduction blocking agent onto the skin or mucous membrane; tissue affect is limited to the are in contact with the anesthesia

Drug Sources

Plant, animal mineral, laboratory synthesis, & biotechnology

Benzodiazepines

Preoperative sedative

Antibiotic

Prevents & treats infection

Antocoagulant

Prevents clot or thrombin formation

Antiemetics

Prevents nausea & vomiting

Anti-inflammatory

Prevents or treats pain, redness, swelling, or heat

Passive Transport

Process of diffusion that requires no energy, the drug is absorbed or taken into the bloodstream by the capillaries from an area of higher concentration to an area of lower concentration

Bier Block

Provides anesthesia to the distal portion of the upper extremity by injecting a large volume of low-concentration

How is medication dosage commonly expressed?

Ratio of medication concentration per kilograms of patient body weight

Anesthetic

Reduces mental anxiety & promotes sleep

Food & Drug Administration (FDA)

Regulation of pharmaceuticals in the United States

Antipyretic

Relieves fever

Analgesic

Relieves pain

Neuromuscular Blockade

Reversal of nondepolarizing neuromuscular agent

Immunoglobin

RhoGram given to a RH-negative women who is pregnant with a RH -positive fetus

Solutions used in the OR room setting

Ringer's solution, Lactated Ringer's (LR) soluion, 5% dextrose solution, 0.9% saline solution

What if the late sign of Malignant Hypothermia?

Rise in temperature as high as 107 F

Hormone

Secretion of endocrine gland

Ointment

Semisolid drug form, primarily oil-based; not easily absorbed; better at protecting & preventing water loss

Cream

Semisolid drug form, primarily water-base, 50% with oil; easier to absorb

Neuromuscular Blockade

Skeletal muscle relaxants, interfere with the passage of impulses form the motor nerves to skeletal muscles resulting in muscle weakness & paralysis

How should the Surgical Tech handle bone wax?

Soften the bone wax by kneading prior to use, then rolled into small balls that are then applied to the wound site with the back of a flat instrument

Why can drug classification become confusing?

Some of the classifications overlap & a specific drug may be cross-referenced in several categories

What should the surgical technologist do when passing medication to the surgeon?

State the name of the drug, strength and amount

Bone Wax

Sterile mixture of beeswax applied to the cut edges of bone; used in thoracic, neurosurgery, orthopedic & ENT surgery

Pharmadynamics

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

Agent Instillation

The administration of medication into an area such as the rectum, where the agent is absorbed via the mucous membranes & transported to the CNS by the circulatory system

Maintenance Phase of General Anesthesia

The anesthesia care provider monitors the patient closely for changes in oxygen saturation, blood loss, muscle relaxation status & cardiac status

Therapeutic Effect

The concentration or dose of a medication used to produce the desired result without producing harmful effects

Pharmacokinetics

The entire process of absorption, distribution, biotransformation/metabolism & excretion

Local Anesthesia

The injection of a nerve conduction blocking agent into the tissues surrounding a peripheral nerve (s) that serve only the tissue at the site of surgical intervention

Agent Injection

The intravenous administration of medications directly into the bloodstream

Duration

The overall period of time that the effects of the medication occur

What can Malignant Hypothermia be triggered by?

The use of succinylcholine curare, halogenated inhalation agents, or strenuous exercise , stress of trauma

The 3 names given to drugs

Trade, generic, chemical

Dantrolene

Treatment for malignant hyperthermia

Adverse Effect

Undesirable & potentially harmful effect that can lead to organ damage or failure

What is the 1st sign of Malignant Hypothermia?

Unexplained tachycardia followed by tachypnea & increased level of carbon dioxide

Vasopressin

Used in the cervix or uterine fibroid to reduce intraoperative bleeding

How should the method of beeswax be used?

Used sparingly because the body recognizes beeswax as a foreign body & this may cause tissue reaction & rejection

Oxytocic drugs

Used to induce labor, & control uterine hemorrhage associated with pregnancy & childbirth

Lubricants

Used to protect the cornea when the eye is unable to close or when the natural lubrication of the eye is impaired, prevent corneal drying

Neuroleptanalgesia

Uses high doses of neurleptics & narcotic analgesic agents to induce a state of diminished anxiety, sedation, & amnesia

Neuroleptanesthesia

Uses neuroleptanalgesia techniques supplemented with an inhalation agent

Nonpolarizing Agents

Work by competing for postsynaptic receptor sites at the neuromuscular junction, prevents acetylcholine from being able to stimulate muscle contraction.

Depolarizing Agents

Work by mimicking a release of acetylcholine across the neuromuscular junction

Pharmacology

the study of medications & their actions including drug origins, properties, & uses

100mL =

1gtt

1g =

1gtt

1kg =

2.2lb

1mL =

15 minims

1 minim =

0.1L

Boiling point 212 F =

100 C

1meter =

1000cm

1L =

1000mL