Pharmacology
Lecture #2
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 purposes
Read Medication Labels and Check
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Name (trade &
generic)
Manufacturer
Strength
Amount
Expiration
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Route
 Lot number
 Handling/Storage
directions
 Classification (if
controlled substance)
Identification
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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
technologist
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 labeled
The Six Rights

Right Patient
 Right Drug
 Right Dosage/Amount
 Right Route
 Right Time and Frequency
 Right Labeling/Documentation (new as of 2007)
 It is the responsibility of the circulator and
surgical technologist to verify this
information
MEDICATIONS
 Antibiotics
 Ophthalmic
agents
 Diagnostic Agents
 Local Anesthetics
 Diuretics
 Drugs Affecting Coagulation
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 cells
ANTIMICROBIALS
MICROORGANISM
Antibiotics
Bacterial
Staphlococcus Aureaus
Fungi
Ring worm, athletes foot,
yeast
Viruses
Herpes, Hepatitis C, HIV
Parasites
Malaria, trichomoniasis
Protozoa
Giardia, dysentary
Antifungals
Antivirals
Antiparasitics
Antiprotozoals
Medications Used in Surgery
 Antibiotics
 Are
given pre-operatively, intra-operatively,
and post-operatively for prevention of
bacterial infection. They can be
administered intravenously, intramuscularly, 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 purposes
Antibiotics
 Their
action may be bacteriostatic
(inhibitive of bacterial growth) or
bactericidal (bacteria killing)
 Are a type of antimicrobial
Types of Antibiotics
 Aminoglycosides
 Cephalosporin's
 Macrolids
 Penicillin's
 Tetracycline's
 Each
type has a variety of antibiotics in that
category
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.
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.
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.
Penicillin's
 obtained from
Penicillium molds
 Penicillin acts by destroying the cell wall of
bacteria.
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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.
Tetracycline's
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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.
Ophthalmic Agents
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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 nerve
Eye Anatomy cont.
Types of Ophthalmic Agents
 Enzymes
 Irrigating
 Viscoelastic
 Miotics
 Mydriatics
 Ointments
& Lubricants
 Anti-inflammatories
 Dyes
 Anesthetics
Enzyme Agents
 Speed
up chemical reactions when mixed
with anesthetic agents
 Wydase (Hyaluronidase)
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 procedures
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)
Miotic Agents
 Constrict
the pupil
 Post-cataract extraction to maintain
implanted lens position
 Laser iridectomy
 Pilocarpine
Mydriatic Agents
 Paralytic
agents used to dilate the pupil
 Atropine
 Neo-Synephrine
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-inflammatory
 Maxitrol and Tobradex
Anti-inflammatory Agents
 Steroids
 Suppress
inflammatory response from
traumatic eye injury
 NSAIDs
 Decrease or minimize post-operative
inflammation
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)
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 effect
Diagnostic Agents
Includes:
 Contrast media
 Dyes
 Staining Agents
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 dyes
 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 contrast
Dyes
 Used
for marking skin as well as detecting
injury in the urinary tract
 Types include: Methylene blue, Indigo
carmine, and Gentian violet
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 uterus
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 sensitive
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
field
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 biopsied
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
laser
Local Anesthetics
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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 pain
Local Anesthetics
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Lidocaine (.5%, 1%, 1.5%, 2%)
Marcaine (Bupivicaine) .25%, .5%, .75%
a. with epinephrine
b. without epinephrine
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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!
Local Anesthetics
 Cocaine
 Nasal
surgery
 Vasoconstrictor and mucous membrane
anesthetic
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)
Diuretics Continued
 Surgical
uses:
 Prevent complications previously
mentioned as well as reduce intraocular
pressure and to reduce intracranial pressure
Types of Diuretics
 Different
types of diuretics have different
mechanisms of action
 Types include:
 Loop Diuretics
 Thiazide Diuretics
 Potassium Sparing Diuretics
 Carbonic Anhydrase Inhibitors
 Osmotic Diuretics
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.
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.
Potassium Sparing Diuretics
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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.
Carbonic Anhydrase Inhibitors
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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.
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.
Diuretics in the OR
 Lasix
 Bumex
 Aldactone
 Mannitol
 These
are given IV by the CRNA during
surgery
Drugs Affecting Coagulation
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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)
Anticoagulants
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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 bleeding
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 topically
 Systemic Coagulants are used IV
 Hemostatics are widely used in surgical
procedures
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 efficacy
Types of Hemostatics
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Thrombin
 Comes in a powder that is mixed with
preservative free sterile normal saline
 May 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
weeks
Types of Hemostatics
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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 Powder
Can 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 bone
Types of Hemostatics
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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 closure
Types of Hemostatics
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Surgicel and Oxycel
 Is a mesh, gauze-like material
 Excess should be removed before wound
closure
 Helistat
 Soft, pliable, sponge-like material
 Apply with dry instruments and or dry gloves
 Remove excess before wound closure
Other Hemostatic Methods
 Phenol
and Alcohol
 Will see used with appendectomy or GI
surgery
 Phenol will burn tissue and can cause
severe burns
 Alcohol neutralizes the phenol after it is
applied to the site it is intended for
Other Hemostatic Methods
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Styptics
1. Epinephrine is a vasoconstrictor
Vasoconstriction reduces the lumen size of vessels
which reduces blood loss
Will 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 surgery
Summary
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Care & Handling of
Medications and
Solutions:
Medication
Identification
Labeling
5 Rights
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Medications Used in
Surgery:
Antibiotics
Diagnostic Agents
Diuretics
Drugs Affecting
Coagulation