Pharmacology Lecture #2 - PowerPoint Presentation

Slide1

Pharmacology Lecture #2

Slide2

Care and Handling of Medications and Solutions

Medication Identification:

Medications come in a variety of packaging

Glass, Metal, and Plastic

Common Types of Containers in the OR:

Ampule Tubes

Vial Paper

Preloaded syringe Foils/plastic

Glass breaks and is considered a sharp for disposal purposesSlide3

Read Medication Labels and Check

Name (trade & generic)

Manufacturer

Strength

Amount

Expiration

Route

Lot number

Handling/Storage directions

Classification (if controlled substance)Slide4

Identification

Name, strength, amount, and expiration should be checked three times before use

1. When obtained

2. Prior to preparation or delivery to sterile field

3. After on the sterile field and prepared for use will be labeled by the surgical technologistSlide5

Labeling Medications

Medications are labeled according to institutional policy

Some labels come prepared sterile

Blank labels are included in sterile packs and can be written on with a sterile marker

Steri-strips can be used as labels when none are available and written on with a sterile marker

Syringes and med cups should be labeledSlide6

The Six Rights

Right Patient

Right Drug

Right Dosage/Amount

Right Route

Right Time and FrequencyRight Labeling/Documentation

(new as of 2007)

It is the responsibility of the circulator and surgical technologist to verify this

informationSlide7

MEDICATIONS

Antibiotics

Ophthalmic agents

Diagnostic Agents

Local Anesthetics

DiureticsDrugs Affecting CoagulationSlide8

Antimicrobials and Their Action

Inhibit synthesis of cell wall

Interfere with synthesis of protein

Alter the function of cell walls

Prevent RNA or DNA production (cell replication)

Interfere with metabolism of cellsSlide9

ANTIMICROBIALS

MICROORGANISM

Antibiotics

Bacterial

Staphlococcus Aureaus

Antifungals

Fungi

Ring worm, athletes foot, yeast

Antivirals

Viruses

Herpes, Hepatitis C, HIV

Antiparasitics

Parasites

Malaria, trichomoniasis

Antiprotozoals

Protozoa

Giardia, dysentarySlide10

Medications Used in Surgery

Antibiotics

Are given pre-operatively, intra-operatively, and post-operatively for prevention of bacterial infection. They can be administered intravenously, intra-muscularly, orally, topically as an ointment, and in an irrigation form

In the OR the ST will handle antibiotics that will be mixed with normal saline for irrigation purposesSlide11

Antibiotics

Their action may be bacteriostatic (inhibitive of bacterial growth) or bactericidal (bacteria killing)

Are a type of antimicrobialSlide12

Types of Antibiotics

Aminoglycosides

Cephalosporin's

Macrolids

Penicillin's

Tetracycline'sEach type has a variety of antibiotics in that categorySlide13

Aminoglycosides

A group of antibiotics (such as gentamicin, polymyxin) that inhibit bacterial protein synthesis and are particularly active against Gram-negative bacteria.

Often used in eye cases.Slide14

Cephalosporin's

one of several broad spectrum antibiotic substances obtained from fungi and related to penicillin (trade names Mefoxin and Keflex).

prescribed for bacterial infections of the respiratory tract, the middle ear, the bones, the skin, and the reproductive and urinary systems.Slide15

Macrolids

A group of antibiotics produced by various strains of Streptomyces.

eg

, clarithromycin, azithromycin

used to treat infections such as respiratory tract and soft tissue infections.Slide16

Penicillin's

obtained from Penicillium molds

Penicillin acts by destroying the cell wall of bacteria.

may be used to treat infections such as urinary tract infections, septicemia, meningitis, intra-abdominal infection, gonorrhea, syphilis, pneumonia, respiratory infections, ear, nose and throat infections, skin and soft tissue infections.Slide17

Tetracycline's

derived from microorganisms of the genus Streptomyces and used broadly to treat infections.

A "broad-spectrum" antibiotic, is used to treat bacterial infections such as Rocky Mountain spotted fever, typhus fever, and tick fevers; upper respiratory infections; pneumonia; gonorrhea; amoebic infections; and urinary tract infections.

It is also used to help treat severe acne and to treat trachoma (a chronic eye infection) and conjunctivitis (pinkeye).

Tetracycline is often an alternative drug for people who are allergic to penicillin.Slide18

Ophthalmic Agents

Are multiple eye medications most given topically

ST must know what each agent does to know in what order to pass it to the surgeon

Eye Anatomy:

Conjunctiva

Anterior chamber (aqueous humor)

Iris/ciliary muscle

Posterior chamber (aqueous humor)

Pupil

Lens

Vitreous body (vitreous humor)

Retina (rods & cones)

Optic nerveSlide19

Eye Anatomy cont.Slide20

Types of Ophthalmic Agents

Enzymes

Irrigating

Viscoelastic

Miotics

Mydriatics

Ointments & Lubricants

Anti-inflammatories

Dyes

Anesthetics Slide21

Enzyme Agents

Speed up chemical reactions when mixed with anesthetic agents

Wydase (Hyaluronidase)Slide22

Irrigating Agents

Corneal moisture and operative site cleansing

BSS - Balanced salt solution – most common in our area

A-K Rinse

Blinx

Irigate

ST may need to irrigate as surgeon performs eye proceduresSlide23

Viscoelastic Agents

Thick, jelly-like substance injected into anterior chamber to maintain expansion of the chamber and prevent injury to surrounding structures and tissue

May be used as vitreous substitute as well

Healon and Viscoat (Sodium Hyaluronate)

Occucoat (hydroxypropyl mthylcellulose)Slide24

Miotic Agents

Constrict the pupil

Post-cataract extraction to maintain implanted lens position

Laser iridectomy

Pilocarpine Slide25

Mydriatic Agents

Paralytic agents used to dilate the pupil

Atropine

Neo-SynephrineSlide26

Ointments & Lubricants

Prevent damage to the cornea from drying during general anesthesia

Lacrilube or Duratears

Prevent eye infections post-ophthalmic surgery

Erythromycin, Neosporin, Tobramycin, Gentamycin

Combination antibiotic/anti-inflammatoryMaxitrol and TobradexSlide27

Anti-inflammatory Agents

Steroids

Suppress inflammatory response from traumatic eye injury

NSAIDs

Decrease or minimize post-operative inflammationSlide28

Dyes

Color or mark eye tissue

Help locate abnormalities or foreign bodies

Abnormal eye cells take up staining agents

Rose bengal

(commonly used in eye drops to stain damaged conjunctival and corneal cells and thereby identify damage to the eye.)Fluorescein sodium (Ful-Glo) (

chemical dye used to identify and locate damage to the surface of the eye; useful in the management of diabetic retinopathy and macular degeneration)Slide29

Anesthetic Agents

Topical anesthesia for short ophthalmic surgical procedures

Tetracaine (Pontacaine) and Proparacaine

OR

Lengthy ophthalmic procedures get a “retrobulbar” block (sensory and motor block)

Lidocaine or Bupivicaine (Marcaine)

May mix with Wydase to prolong effect or Epinephrine to vasoconstrict tissue to prolong anesthetic effectSlide30

Diagnostic Agents

Includes:

Contrast media

Dyes

Staining AgentsSlide31

Contrast Media

Used in radiographic diagnostic tests to enhance visualization

Most contain iodine, a radiopaque compound

Being radiopaque it illuminates tumors, stones, blockages, veins, and arteries (where ever it is injected)

Types include: Omnipaque & Hypaque

Often incorrectly referred to as dyesSlide32

Omnipaque

used in vascular procedures

Hypaque

is used in operative cholangeograms

Are others as well

Are light sensitive and should be stored in closed box or with something over them to protect them from light which alters the efficacy of the contrastSlide33

Dyes

Used for marking skin as well as detecting injury in the urinary tract

Types include: Methylene blue, Indigo carmine, and Gentian violetSlide34

Methylene Blue

Is a blue dye, usually diluted with normal saline, and injected into the bladder to determine leaks in the urinary tract when pelvic surgeries are being performed

May also be injected into the fallopian tubes or uterusSlide35

Indigo Carmine

Is a blue dye given IV to verify that bladder function and kidney function are intact

Needs to be stored out of the light as it is light sensitiveSlide36

Gentian Violet

A purple dye primarily used to mark incision sites

Comes in a sterile marking pen which are included in most custom packs

These are what you will use to write on the labels of your medications on your sterile fieldSlide37

Staining Agents

Primarily used to identify cervical tissue that is abnormal

Types include Lugol’s Solution and Acetic Acid

Lugol’s solution

has an iodine component that in normal tissue is absorbed by the cell, but in abnormal tissue it is not absorbed leaving the tissue white verses dark

The white tissue is identified as abnormal and biopsiedSlide38

Staining Agents

Acetic Acid (vinegar)

Used as staining agent if patient is iodine sensitive or if lasers are being used

Acetic Acid makes the abnormal tissue appear whiter than normal tissue as well

With laser surgery, dark stained tissue (Lugol’s) will react less effectively with the laserSlide39

Local Anesthetics

Primarily used in short or minor operations

May be used in conjunction with general or regional anesthesia

Delivered by injection directly to the operative site

Will be prepared by the surgical technologist on the sterile field and given to the surgeon prior to incision and prn during surgery

Many surgeons also will administer local to the wound edges prior to closure to prolong the onset of post-operative painSlide40

Local Anesthetics

Lidocaine (.5%, 1%, 1.5%, 2%)

Marcaine (Bupivicaine) .25%, .5%, .75%

a. with epinephrine

b. without epinephrine

Injection is with a control syringe with appropriate sized needle (27 or 25ga initial)

22ga post-incision

MUST KEEP UP WITH AMOUNTS GIVEN! CAN WRITE ON A TOWEL OR ON A GLOVE OR GOWN TAG!Slide41

Local Anesthetics

Cocaine

Nasal surgery

Vasoconstrictor and mucous membrane anesthetic Slide42

Diuretics

Given to prevent the kidneys from reabsorbing Na+ and water

Reabsorption of these can cause a variety of patient complications including but not limited to edema (swelling), pulmonary edema (fluid in the lungs), and congestive heart failure (increased circulatory blood volume which results in the heart being overworked>enlarged heart chambers>defective heart valvular function)Slide43

Diuretics Continued

Surgical uses:

Prevent complications previously mentioned as well as reduce intraocular pressure and to reduce intracranial pressureSlide44

Types of Diuretics

Different types of diuretics have different mechanisms of action

Types include:

Loop Diuretics

Thiazide Diuretics

Potassium Sparing DiureticsCarbonic Anhydrase InhibitorsOsmotic

DiureticsSlide45

Loop Diuretics

diuretics that act on the ascending loop of Henle in the kidney.

They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or renal insufficiency.Slide46

Thiazide Diuretics

They work by inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys.

Thiazides are often used to treat hypertension, although they are also used to treat congestive heart failure and symptomatic edema.Slide47

Potassium Sparing Diuretics

Potassium-sparing diuretics are commonly used to help reduce the amount of water in the body. Unlike some other diuretics, these medicines do not cause your body to lose potassium.

They are used as adjunctive therapy, together with other drugs, in the treatment of hypertension and management of congestive heart failure.Slide48

Carbonic Anhydrase Inhibitors

Often used for opthalmic purposes.

The drug decreases fluid formation in the eye resulting in lower intraocular pressure.

The drug forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic.

Acidifying the blood stimulates ventilation, which increases the amount of oxygen in the blood.Slide49

Osmotic Diuretics

a type of diuretic that inhibits reabsorption of water and sodium.

An example is Mannitol.

Mannitol can also be used to reduce intracranial pressure.Slide50

Diuretics in the OR

Lasix

Bumex

Aldactone

Mannitol

These are given IV by the CRNA during surgerySlide51

Drugs Affecting Coagulation

Our blood contains components that either inhibit its ability to clot or promote that

ability

Anticoagulants

inhibit clotting

Coagulants

promote clotting

Normally, blood is maintained in its liquid form by the abundance of anticoagulants in our bodies

When our body experiences trauma, coagulants create clot at the site of injury to prevent blood loss (ex. scab formation) Slide52

Anticoagulants

Prolong blood clotting

Primarily used in cardiovascular procedures

As an irrigant are diluted with normal saline to prevent clotting at the operative site

Prevent clot formation in the patient’s circulatory system when given IV

Most commonly used anticoagulant is

heparin

Drug used to reverse heparin when given IV is

protamine

Prevents heparin from bonding to the cell receptors it had previously bonded with

Protamine given alone (not in presence of heparin is an anticoagulant)

Primary concern with heparin use is bleedingSlide53

Coagulants

Are used to promote clotting of the blood

Can be topical or IV

Two types:

1)Hemostatics and 2)Systemic Coagulants

Hemostatics are used topicallySystemic Coagulants are used IVHemostatics are widely used in surgical proceduresSlide54

Hemostatics

These products actually assist to form clot at the operative site

They come in a variety of forms: powders, sponges, solutions, films, and fiber-like material

They are

not

for injection, but for topical use only

May see some that are combined with others to make them more practical to use as well as to enhance their efficacySlide55

Types of Hemostatics

Thrombin

Comes in a powder that is mixed with

preservative free

sterile normal salineMay see it used to soak the sponge material the next type for application to a surgical site

Gelfoam

Sponge like material

Can be left in the patient as it absorbs in 4 to 6 weeksSlide56

Types of Hemostatics

Gelfilm

Used in neuro, thoracic, and ophthalmic surgeries

Looks like cellophane in dry form, but is elastic when wet with thrombin or saline

Absorbed by the body, so is safe to leave in the patient’s body

Gelfoam PowderCan be sprinkled on to a site or combined with antibiotic powder, thrombin, or saline to form a mushy ball that can be spread on to boneSlide57

Types of Hemostatics

Avitene

Comes in powder or fiber-like material

Surgical site should be as dry as possible before it is applied to get the maximum benefit (applies to any hemostatic)

A sponge is usually applied afterwards to apply pressure to promote efficacy (applicable to any hemostatic)

Use clean, dry forceps to apply (commonly use ring forceps with the powder)

Excess should be removed before wound closureSlide58

Types of Hemostatics

Surgicel and Oxycel

Is a mesh, gauze-like material

Excess should be removed before wound closure

Helistat

Soft, pliable, sponge-like materialApply with dry instruments and or dry gloves

Remove excess before wound closureSlide59

Other Hemostatic Methods

Phenol and Alcohol

Will see used with appendectomy or GI surgery

Phenol will burn tissue and can cause

severe

burnsAlcohol neutralizes the phenol after it is applied to the site it is intended forSlide60

Other Hemostatic Methods

Styptics

1.

Epinephrine

is a vasoconstrictor

Vasoconstriction reduces the lumen size of vessels which reduces blood lossWill see combined with topical agents such as Gelfoam and combined in lidocaine or marcaine, medications used for numbing a surgical site

2.

Silver Nitrate

used on burns from trauma

3.

Tannic Acid

used on the mucous

membranes in nose and throat surgerySlide61

Summary

Care & Handling of Medications and Solutions:

Medication

Identification

Labeling

5 Rights

Medications Used in Surgery:

Antibiotics

Diagnostic Agents

Diuretics

Drugs Affecting Coagulation