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Pharmacology

answer

the study of medications and their actions

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drug

answer

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

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prophylaxis

answer

prevention of a disease or condition

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5 Main Drug Sources

answer

plants, animals minerals, laboratory synthesis, biotechnology

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plants

answer

morphine and digitalis

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animals

answer

heparin sodium and thrombin

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minerals

answer

calcium, gold, iron, magnesium, silver, zinc

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laboratory synthesis

answer

synthetic and semisynthetic drugs

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synthetic drugs

answer

manufactured totally from laboratory chemicals; Meperidine sulfate

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semisynthetic drugs

answer

begin witha natural substance which is then chemically altered

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biotechnology

answer

the newest source of drugs from the laboratory comes to use from genetic engineering; referred to as recombinant DNA technology; hep B vaccine produced through this method

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pharmacodynamics

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involves the study of the interaction of drug molecules with the target cells of living tissue

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pharmacokinetics

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the term used to describe the entire process of the drug within the body

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agonists

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this interaction occurs when a drug potentiates or enhances the effect of another substance; synergists and additives are to examples of this

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synergists

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

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additives

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alter some aspect of the action of the original agent; ex: use of epinephrine and lidocaine to prolong anesthetic action

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antagonists

answer

binds to the agonists receptor site preventing it from bending there and causing its desired effect; this results in the absence of the agonists action referred to as agonist reversal

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agonist

answer

a medication that binds to a specific receptor site in the body producing an alteration in biological function and resulting in a desired effect

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indications

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

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contraindications

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a list of circumstances or medical conditions under which the medication should not be used

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onset

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the period of time required for the effects of the medication to begin to be demonstrated on the patient

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peak effect

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the period of time when the maximum effects of the medication are demonstrated in the patient

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duration

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the overall period of time when the effect from a medication can be demonstrated in the patient

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therapeutic effect

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

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side effect

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an expected undesirable but tolerable effect of a medication

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adverse effect

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an undesirable and potentially harmful effect of a medication that can lead to organ damage or failure; common one is allergic reaction

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toxic effect

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undesirable and unacceptable effects of a medication; can include promotion of growth of tumors or birth defects

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tolerance

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the reduction in the effect of a medication given at the same dose over a period of time; the dosage of the medication must be increased in order to demonstrate the desired affect

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addiction

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a physical or psychological dependency on the effects of medication

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absorption

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occurs at the site of administration where the substance is taken into the bloodstream by the capillaries; referred to as passive transport

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distribution

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involves the transport of the medication within the body once it enters the circulatory system

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main function of the liver in metabolism

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to break down the drug molecules, using enzymes in preparation for excretion

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the kidneys

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primarily responsible for the filtration of medications form the blood and excretion of medications and metabolites as part of urine formation and excretion

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enteral

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oral and rectal

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oral

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PO, per os or by mouth; through the gastrointestinal tract

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rectal

answer

placed into the rectum

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parenteral

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other than through the gastrointestinal tract; by injection

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intradermal

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between the layers of the skin, TB test

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subcutaneous

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under the skin into the adipose tissue layer; insulin

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intramuscular

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within a muscle; flu shots

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intravenous

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into a vein

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intra-articular

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within a joint; steroids, synovial fluid

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intrathecal

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into the subarachnoid space; spinal tap, epidural

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intracardiac

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into the heart; epinephrine/adrenaline

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topical

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applied to the skin or mucous membrane to provide a localized or systemic effect

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buccal

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medication is placed between the cheek and the teeth until it is dissolved or absorbed

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sublingual

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medication is placed under the tongue until it is dissolved or absorbed; nitroglycerine, vitamin D

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instillation

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medication is placed into a hollow or cavity such as the conjunctival fold or bladder; eyedrops

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inhalation

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medication is directly administered via the respiratory tract; asthma drugs

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Pharmacopeia of the United States (USP)

answer

contains information on medications used in current medical practice

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Physician's Desk Reference (PDR)

answer

not an official pharmacological listing; commonly used by physicians for referencing medications for prescription

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Gas

answer

oxygen and nitrous oxide are included in this category

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liquid

answer

two primary types of liquid preparations: solution and suspension

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solution

answer

drug or solute is dissolved in a liquid or solvent

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aqueous

answer

solution prepared with water

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syrup

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sweetened aqueous solution

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tincture

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solution prepared with alcohol

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elixir

answer

sweetened alcohol solution

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suspension

answer

solid particles are suspended in a liquid; may settle and must be redistributed by shaking prior to administration

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emulsion

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combination of two liquids that cannot mix like oil and vinegar; small droplets of one liquid are dispersed or suspended throughout the other

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semisolid

answer

creams, foams, gels, lotions, ointments, and suppositories

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Three Legal Drug Classifications

answer

controlled substances, prescribed medications, and over the counter medications

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controlled substances

answer

drugs with a high potential to cause psychological and or physical dependence and abuse; have classes; need triplicate prescription

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Class I Controlled substance

answer

high abuse potential and no current approved medical use (heroin, marijuana, LSD, some opiates)

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Class II controlled substance

answer

includes drugs that have a high abuse potential and a high ability to produce physical or psychological dependence for which there is a current approved or acceptable medical use

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Class III controlled substance

answer

includes drugs for which there is less potential for abuse than drugs in schedule II and for which there is a current approved medical use; codeine and anabolic steroids

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Class IV controlled substance

answer

includes drugs for which there is a relatively low abuse potential and a current approved medical use

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Class V controlled substance

answer

consist mainly of preparation containing limited amounts of certain narcotic drugs; may be bought without a prescription by an individual at least 18 years of age

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Only registered individuals

answer

allowed to handle controlled substances in the hospital setting

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prescription medications

answer

those medications that if used inappropriately could cause significant harm to the patient

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prescription

answer

includes the name dose quantity and timing of a medication

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over the counter medications

answer

pharmacologic agents that are prepared in a dosage that are generically safe to administer without the direction of a physician; often weaker doses of prescription medications

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Three Names Assigned to Each Drug

answer

trade name, generic name, and chemical name

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trade, brand or proprietary name

answer

name assigned to a medication and copyrighted by the manufacturer for marketing purposes; capitalized; ex: Tylenol

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generic name

answer

non proprietary name for a drug; shortened version o f the chemical name; lower case letters; acetaminophen

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chemical name

answer

the precise chemical composition and molecular structure of the medication; not included on label but on package insert

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Drug classifications

answer

determined by their principal action; examples: barbiturates, neurological agents, anticonvulsant

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Phenobarbital

answer

an example of a drug that fits into the categories barbiturate, neurologic agent, central nervous system depressant, and anticonvulsant

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theory of drug receptor interaction

answer

states that the active substance in the drug has an affinity for a specific chemical constituent of a cell

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theory of drug-enzyme interaction

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argues that a drug may combine with a specific enzyme to inhibit the action of the enzyme or alerter the cellular response to the enzyme

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nonspecific drug interaction

answer

related to drugs that do not act by either of the two previously described methods and are considered nonspecific in their interaction

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dosage

answer

amount of medication delivered to the patient in order to achieve the desired therapeutic effect

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concentration

answer

the ratio of solute to solvent

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dose

answer

amount of medication delivered to the patient

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application

answer

the medication's use in the surgical setting

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Ampule

answer

glass container that requires the top to be broken off to access the contents-usually contains liquid

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Vial

answer

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

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Preloaded syringe

answer

usually contains liquid

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Tube

answer

metal or plastic, may contain cream, gel, or ointment

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verified three times

answer

medication name, strength, amount, and expiration date

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first identification

answer

occurs when the drug listed on the preference card is obtained from the storage area or removed from the case cart for the procedure

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second identification

answer

done prior to preparation for use or placement on the sterile field

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third identification

answer

done once the medication is prepared for use or placed on the sterile field

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fourth identification

answer

verbal identification as STSR passes medication to the surgeon

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Medication must be labeled

answer

immediately following transfer of a medication to the sterile field

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Immediately discarded

answer

medication that the identity or strength is in question

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The circulator holds the medicine bottle

answer

so that both individuals can read the label

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Medications are verbally identified

answer

every time the STSR passes the medication to the surgeon

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All team members

answer

should be aware that a medication is being administered

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general and regional anesthesia

answer

Two main ways of administering anesthetic agents

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general anesthesia

answer

focuses on altering the patient's level of consciousness, thereby minimizing pain and awareness of the surgical environment

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regional anesthesia

answer

involves the prevention of sensory nerve impulse transmission in a specific region of the body, allowing the patient to remain conscious but not feel the pain of the procedure

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Agent inhalation

answer

involves the delivery of gases across the alveolar membrane to the vascular system, where the agent is able to cross the blood-brain barrier affecting CNS function

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Agent injection

answer

involves the administration of medications directly into the bloodstream intravenously

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Agent instillation

answer

involves the administration of medication into an area such as the rectum where the agent is absorbed via the mucous membranes and transported to the CNS by the circulatory system; used on non cooperative patients

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Stage I of Anesthesia

answer

amnesia stage; initial administration to loss of consciousness

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Stage II of anesthesia

answer

excitement or delirium stage; loss of consciousness to return of regular breathing

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Stage III of anesthesia

answer

surgical anesthesia stage; onset of regular breathing to cessation of breathing

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Stage IV of anesthesia

answer

overdosage stage; dilated and nonreactive pupils and cessation of respiration and marked hypo-tension leading to circulatory failure; leads to death if uncorrected

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Induction phase

answer

involves altering the patients level of consciousness from the conscious state to the unconscious state

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Maintenance phase

answer

surgical intervention takes place during this phase; maintenance of homeostatic function of all vital organs critical to successful anesthetic delivery and surgical outcome

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Emergence phase

answer

occurs as the surgical intervention is being completed; goal is to have the patient as awake as possible at the end of surgical intervention

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Recovery phase

answer

the period of time during which the patient returns to the optimum level of consciousness and well-being usually begins in OR and carries through PACU or even through the initial healing stages

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Anesthesia mortality

answer

one per 200,000

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NPO

answer

non per os, nothing by mouth

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Sellick's maneuver

answer

application of cricoid pressure, performed to reduce the risk of aspiration; external pressure applied to cricoid cartilage causing occlusion of the esophagus between cricoid ring and body of sixth cervical vertebrae

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laryngospasm

answer

sudden involuntary contraction of the larynx capable of causing partial or total occlusion of the larynx

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Malignant hyperthermia

answer

a potentially fatal hypermetabolic state of muscle activity resulting from a defect in calcium transportation within the muscle fibers of skeletal muscles

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Malignant hyperthermia triggers

answer

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

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Dantrolene

answer

only pharmacological agent for the treatment of MH crisis

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shock

answer

an abnormal physiological state indicated by the presence of reduced cardiac output, tachycardia, hypotension, and diminished urinary output

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oxygen

answer

not classified as an anesthetic agent but is a component of most anesthetic administrations

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nitrous oxide

answer

a clear, colorless gas with a subtle fruity odor and is the only true gas still in use

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volatile agents

answer

consist of a group of liquids whose potent evaporative vapors, when inhaled, produce general anesthesia through interaction with the CNS

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Sevoflurane

answer

ultane; odorless, non-pungent inhalation agent that does not irritate the respiratory tree; ideal agent for adult and pediatric inhalation induction

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Desflurane

answer

suprane; requires the use of a heated vaporizer for administration; safe for patients with hepatic deficiency

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Isoflurane

answer

forane; mildly pungent, must smelling halogenated inhalation agent; can cause hypotension

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Enflurane and halothane

answer

Ethrane and fluothane; less commonly used; rapid action

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intravenous agents

answer

comprise the largest group of surgical pharmacological agents in use today

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inhalation agents

answer

anesthetic agents that are inhaled and pass into the bloodstream via pulmonary functions

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antimuscarinic (anticholinergic)

answer

refers to an agent used to block parasympathetic effects such as salivation and bradycardia

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IV induction agents

answer

go quickly from stage 1 to stage 3; do not provide pain relief or motor impulse blockade but do produce marked sedation and amnesia

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Propofol

answer

Diprivan; sedative-hypnotic agent introduced into anesthesia practice in early 90's; named milk of amnesia; agent of choice on day admission patients and short procedures

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Etomidate

answer

nonbarbiturate hypnotic agent used for anesthesia induction

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Thiopental sodium

answer

short acting potent barbiturate that does not provide anesthesia or muscle relaxation but has hypnotic, amnesic, and sedative effects; stored in lipid tissues

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Brevital

answer

methohexital sodium; ultrashort onset and duration of action; agent of choice for achieving short-term loss of consciousness during opthalmology and shock therapy

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dissociative agents

answer

selectively interrupt the associative pathways of the brain; may appear wide awake but unaware of surroundings; produce amnesia and profound analgesia

question

Ketamine hydrochloride (Ketalar)

answer

most commonly used dissociative agent; given via IM or IV; does not produce relaxation or reduce reflexes; causes flashbacks; only used on children 2-10 years of age

question

opiate/opioids

answer

group of narcotics classified as analgesics which also produce sedation

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All opiate/opiods

answer

are Class II controlled substances

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Drugs in opiate/opioid class

answer

opiate morphine sulfate and syntehtic opioids; includes Demerol, fentanyl( Sublimaze), sufentanil (Sufenta), alfentanil (Alfenta), and remifentanil (Ultiva)

question

Demerol or Meperidine

answer

similar in action to morphine; in the opiate class; used to treat moderate to severe pain; can be given IM but given IV when used as anesthetic adjunct

question

Morphine sulfate

answer

used for control of severe pain; given IM as preop sedative/analgesic or postop analgesic, IV as anesthetic agent, or intrathecally via spinal administration

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Sublimaze or Fentanyl citrate

answer

first of the syntehtic narcotic analgesics to be used of ranesthesia administration; rapid onset and short duration

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Sufenta or Sufentanil citrate

answer

similar in nature to fentanyl but five times more potent; given as primary anesthetic or adjunct; procudes analgesia with marked sedation and euphoria; short duration

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Remifentnail hydrocholoride or Ultiva

answer

ultrashort acting synthetic opioid metabolized in blood and muscle tissue; short duration of action (5-10 minutes)

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Neuromuscular blockade antagonism

answer

antagonism of nondepolarizing neuromuscular agents can ber produced through Tensilon and neostigmine or Prostigmin; they are 2 cholinergic drugs that prevent destruction of acetylcholine

question

Antimuscarinic or anticholinergic agents

answer

act as blockers of cholinergic effects; blocks parasympathetic effects such as salivation and bradycardia

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Ketorolac or Toradol

answer

NSAID or nonsteroidal anti-inflammatory agent; used for moderate pain control; given IM to aid in pain management during emergence and recovery

question

Histamine H 2 antagonists and antacids

answer

used to alter pH of gastric secretions and reduce gastric volume; Bicitra, Tagmet, Zantac, and Reglan

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Antiemetic agents

answer

used to prevent or treat postoperative nausea and vomiting; Droperidol, Reglan, or Zofran

question

Ringer's Solution

answer

water based solution for injection that contains essential serum electrolytes; similar to plasma

question

Lactated Ringer's (LR) solution

answer

has sodium lactate added in addition to the electrolytes which enables it to serve as a glucose source for body metabolism; used to correct fluid and electrolyte deficits and mild acidosis

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5% Dextrose solution (D5W)

answer

a solution of water for injection with a 5% concentration of dextrose monohydrate added; serves as source of glucose; used to correct hypoglycemia and replace water lose during normal metabolism

question

0.9% saline solution or normal saline

answer

a solution of water for injection with the addition of sodium chloride; corrects deficits of sodium and chloride to treat metabolic alkalosis; used in OR when blood products being administered

question

Induced hypothermia

answer

involves the artificial, deliberate lowering of the body's core temperature below normal limits; permits lower dosages of inhalation and IV agents; safer level of anesthetic agent administration

question

Moderate hypothermia

answer

89.6-78.8

question

Profound hypothermia

answer

below 68 degrees

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Induced hypotension

answer

an adjunctive therapy involving a controlled decrease of arterial pressure during anesthetic administration; results in decrease in bleeding and blood loss

question

Methods of Inducing Hypothermia

answer

body surface cooling, internal cavity cooling, systemic blood circulation cooling

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Neuroleptanalgesia

answer

utilizes high doses of neuroleptics (tranquilizers) and narcotic analgesic agents to induce a state of diminished anxiety, sedation, and amnesia, allowing the patient to retain the ability to respond to commands

question

Neuroleptoanesthesia

answer

occurs when neuroleptanalgesia is reinforced with an inhalation or IV anesthetic agent

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nerve conduction blockade anesthesia

answer

involves the use of pharmaceutical agents to prevent the initiation and/or transmission of sensory nerve impulses

question

techniques for nerve conduction blockade

answer

topical anesthesia, local anesthesia, regional anesthesia, nerve plexus block, spinal or intrathecal block, epidural block. Bier block

question

nerve conduction blocking agents

answer

used to prevent initiation or transmission of impulses along a nerve pathway or plexus; anesthesia near or distal to injection site; these agents referred to as local or regional anesthetics

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Amino Amide Group

answer

metabolized in the liver and excreted byt he kindeys; include lidocaine hydrochloride, mepivacaine hydrochloride, bupivacaine hydrochloride, and etidocaine hydrochloride

question

Lidocaine hydrochloride

answer

Xylocaine or Lignocaine; most widely used local anesthetic agent with rapid onset of action and moderate duration; has properties that affect the function of the heart

question

Mepivacaine hydrochloride

answer

Carbocaine; acts similarly to lidocaine HCL but has longer action

question

Bupivacaine hydrochloride

answer

Marcaine or Sensorcaine; agent that is four times more potent than lidocaine HCL; longer onset and longer duration

question

Amino Ester group

answer

drugs in this group are biotransformed by pseudocholnesterase in plasma and include cocaine hydrochloride, procaine hydrochloride (Novocaine) and tetracaine hydrochloride

question

Cocaine hydrochloride

answer

a CNS stimulant; one of the oldest anestehtic agents; used as topical agent on mucosa of upper aerodigestive tract; controlled substance; shrinks mucous membranes

question

Procaine hydrochloride

answer

Novocaine; similare properties to cocaine HCL but less toxic

question

Tetracaine hydrochloride

answer

Cetacaine, Pontocaine; an agent with a slow onset of action but prolonged duration; used as topical anesthetic on mucous membranes

question

Adjunctive Agents to Nerve Conductions blockade

answer

influence the onset and duration of the action of these agents; hyaluronidase or Wydase and epinephrine or Adrenalin

question

Hyaluronidase

answer

Wydase; added to local infiltration agents to assits in their distribution into the subcutaneous tissues; useful during retrobulbar eye block

question

Epinephrine

answer

adrenalin; potent vasoconstrictor; used as adjunctive agent to nerve conduction blocking agents; limits intraoperative bleeding and prolongs anesthetic effect

question

Drugs containing epinephrine

answer

are color coated red

question

topical anesthesia

answer

involves the placement of a nerve conduction blocking agent onto a tissue layer; provides anesthesia on mucous membranes of upper aerodigestive tract, urethra, vagina, rectum, and skin; administered by the surgeon; achieved by cryoanesthsia or pharmacological agent

question

Cryoanesthesia

answer

involves the reduction of nerve conduction/transmission by localized cooling; accomplished with ice or use of cryoanesthesia machine; freezes superficial nerve endings blocking nerve impulses and eliminating pain

question

Pharamceutical agents

answer

applied directly to thes kin and are absorbed and come in contact with peripheral nerve endings providing anesthesia by preventing the initiation of the nerve impulses; Lidocaine and cocaine two examples

question

Local anesthesia

answer

involves the injection of a nerve conduction blocking agent into the tissues surrounding a peripheral nerve or nerves that serve only the tissue at the site of surgical intervention

question

Monitored Anesthesia Care

answer

MAC; involves a combination of nerve conduction blockade on the topical or local level that is supplemented with analgesics, sedatives, or amnesics; surgeon commonly performs nerve conduction blockade

question

Regional Anesthesia/blockade

answer

involves the administration of an anesthetic usually by the anesthesia provider along amajor nerve tract; blocks conduction from all tissues distal to the injection site; ex: nerve plxus block, Bier block, spinal block, epidural block

question

Nerve plexus block

answer

usually accomplished with the injection of an anesthetic solution in an area of a major plexus; resulting anesthsia includes all tissue innervated by the plexus

question

Bier block

answer

provides anesthesia to the distal portion of the upper extremity by injecting a large volume of low concentration anesthetic agent into a vein at a level below a tourniquet

question

2nd tourniquet inflated

answer

after local anesthetic starts working and first tourniquet deflated

question

Bier block used

answer

on interventions of the extermity of 1 hour duration or less

question

Spinal Block

answer

spinal anesthsia or intrathecal block; injection of an anesthetic agent into the cerebrospinal fluid in subarachnoid space between the meningeal layers of the spinal cord to provide loss of sensation to entire body below the diaphragm

question

Spinal anesthesia onset

answer

effect seen in 3-10 minutes; lasts approximately 1-1 and 1/2 hours

question

Patient cooperation

answer

critical to the successful administration of spinal anesthsia, often sedated prior to needle placement

question

Position

answer

patient usually positiioned in the latera or sitting position; the goal is to expose the intervertebral spaces to allow for needle placement

question

agent baricity

answer

refers to teh specific gravity of the anestehtic solution in comparision to CSF

question

hyperbaric solutions

answer

high specific gravity; tend to settle toward gravity

question

hypobaric solution

answer

low specific gravity; tend to float or move away from gravity

question

isobaric solutions

answer

solutions with the same specific gravity as CSF

question

Rate of injection

answer

affects the agents placement; rapid injection will promote turbulence as it combines iwth CSF; causes it to spread over a larger area of nerve roots resulting in increased area of effect

question

increased CSF pressure

answer

may reult from the position of the OR table, coughing, straining, or muslce contraction; may result in migration of the anesthetic agent and unintended contact with nerve roots controlling major body functions

question

Spinal Anesthetic Agents

answer

most commonly used agent is tetracaine hydrochloride; lidocaine hydrochloride and procaine hydrochloride also used

question

Spinal Anesthetic Additives

answer

epinephrine; intrathecal opioid

question

Advantages of spinal anesthesia

answer

patient remains conscious and in control of their airway; nonirritating to respiratory trea; produces bowel contraction faciliating exposure; excellent muscle relaxant

question

Disadvantages and Complications of SPinal Anesthesia

answer

induced hypotension; nausea or vomiting; no dosage control once administered; spinal headache; can develop temorary or permanent paralysis

question

Narcan

answer

naloxone hydrochloride; can reverse or antagonize the opioid effect; it copetes for CNS receptor sites preventing opioid binding

question

Benzodiazepines

answer

sedative tranquilizers that are used to reduce anxiety in preop and as adjunct to general anesthesia to reduce amount needed of more potent agents; do not produce analgesia

question

Valium and Versed

answer

diazepam and midazolam; two most commonly used benzodiazepines

question

Valium or diazepam

answer

class IV controlled substance; primary anesthetic use is to reduce anxiety and provide skeletal muscle relaxation; retrograde amnesia; metabolized in the liver

question

Versed or Midazolam

answer

class IV controlled substance; rapid onset and short acting benzodiazepine; ideal for outpaitents; twice as potent as diazepam so diluted with saline

question

Droperidol or Inapsine

answer

a butyrophenone; produces marked sedation with a long duration of action; acts as antiemetic

question

Neuromuscular blockers

answer

also called skeletal muscle relaxants; cause muscle weakness/paralysis; jaw relaxation is achieved to facilitate endotracheal intubation; muscles of respiration affected; surgical site muscles relaxed to allow relaxation

question

Depolarizing agents

answer

work by mimicking a release of acetylcholine across the neuromuscular junction

question

fasiculation

answer

visible contraction/relaxation cycle in the muscle; produced by depolarizing agents; patient may experience postoperative muscle ache

question

succinylcholine

answer

anectine; ultrashort-acting agent; rapid onset and useful in producing neuromuscular blockade for intubation

question

nondepolarizing agents

answer

preferred agents for blockade induction; copete for postsynaptic receptor sites at the neuromuscular junction preventing acetylcholine from stimulating muscle contraction

question

Mivacurium chloride

answer

Mivacron; short acting nondepolarizing muscle relaxant with intermediate length of onset

question

Vecuronium bromide

answer

Norcuron; short acting nondepolarizing muscle relaxant with an intermediate onset

question

Rocuronium bromide

answer

Zemuron; short acting nondepolarizing muscle relaxant with a rapid onset; rapid spontaneous recovery; similar to succinylcholine without side effects

question

Atracurium besylate

answer

Tracrium; intermediate acting nondepolarizing muscle relaxant with a short onset

question

Curare

answer

tubocurarine chloride; long acting nondepolarizing muscle relaxant with rapid onset; used by Indians to poison arrows for hunting; causes histamine release and may induce bronchospasm and hemodynamic changes

Chapter 9 Pharmacology and Anesthesia – Flashcards

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