PHARMACOLOGY 1. Pharmacology The study of drugs and their

1. Pharmacology
2. Pharmacodynamics
The study of drugs and their origin, nature, properties, and effect upon
living organisms
The study of drugs and their actions on living organisms
a. Time it takes for a medication to take effect
a. onset
b. Peak affect
b. When the medication reaches it desired effect is greatest without any
major side effects
c. The length of time that a drug is completely effective
c. Duration of action
3. Pharmacokinetics
The study of the metabolism and actions of drugs with emphasis on
absorption, duration, distribution in the body, and method of excretion
a. The movement of a drug through the blood system
a. absorption
b. Medication reaching the target cells or organs in the body
b. Distribution
c. After hitting the target organ for best effects the drug is broken down in
the system into an inactive substance
c. Metabolism
d. The inactive broken down substance is then excreted from the body
through the kidneys, GI tract, lungs and/or excretory glands.
d. Excretion
1. Actions
a. Agonist
Any chemical substance taken into the body for the purpose of affecting
the body's functions
Types of medication actions and effects
a. A substance that binds to receptor cells in the body causing the med to
have its desired affect
b. synergist
b. It is a form of an agonist. Two drugs that work together to form a more
powerful effect for the patient.
Example: when Versed and Fentanyl are given together there is less need
for inhalant dangerous gases during anesthesia
c. Antagonist
A drug which interferes with the receptor cell in the body and causes a drug
to not have its intended affect on the body
d. Addictive
d. Certain drugs when added to another medications will change the affects
of that drug
Example: Epinephrine added to short acting Lidocaine will help to prolong
the drugs effectiveness
2. Therapeutic actions
a. Indications
b. Contraindications
3. Effects
a. Side effects
b. adverse effects
c. toxic effect
d. Tolerance
e. Addiction
1. Chemical name
a. Each drug has a specific use and is listed for use with regards to specific
b. Every drug has a list of conditions that it should not be for.
i.e. pregnancy is a contraindication of many drugs
a. These are undesirable effects from a drug
b. This is also and undesirable effect but could be extremely harmful to the
i.e. Tylenol has an adverse reaction on the liver.
Ibuprofen has an adverse reaction on the kidneys
c. Some drugs can cause toxic situations especially if they are used for a
prolong period of time. They can be toxic to any organ in the body. They
may cause cancer in a patient or they can cause birth defects if the
pregnant mother is taking a certain drug.
d. The patient becomes immune to the medication because they have been
on it too long or too many times
e. A physical and psychological attachment to a drug. Unable to stop the
use of the drug
Types of Names for Drugs
Exact chemical formula of a drug
Usually a long, very difficult name to pronounce and of little concern to the
health care worker
2. Generic name
Common or general name assigned to the drug when it is marketed
Differentiated from trade name by initial lowercase letter
3. Trade name or brand
Name by which a pharmaceutical company identifies its product; is
copyrighted and used exclusively by that company
Can be distinguished from generic name by capitalized first letter
Symbol ® is used behind the name to indicate it is a “registered” trademark.
Medication Classifications
a. These substances are prone to high abuse.
b. These are sanctioned by the FDA. They are street drugs.
c. There is no accepted medical treatment determined for these substances
d. Because the FDA does not sanction these drugs they are not considered
to be safe. Marijuana, Heroin
1. Controlled
substances (Schedule IV)
Schedule I Drugs.
Schedule II
Schedule III
Schedule IV
a. Highly addictive and potential for abuse
b. These have medicinal value for treating a persons diseases or symptoms
but can have severe restrictions
c. Abuse could lead to a dependency for the medication by the person
Examples: codeine, fentanyl, methadone, morphine
a. These drugs have a potential for abuse but less so that Schedule I or II
b. Used for accepted treatment
c. Low physical dependency and potentially high psychological dependency
Examples: Anabolic steroids, Ketamine, hydrocodone, Vicodin, Tylenol 3
a. Low level of abuse compared to I-III
b. They are accepted for treatment of diseases and symptoms
c. Lesser chance of addiction that the other levels of schedule
Examples: Xanax, Valium, Klonopin, Phenobarbitol
Schedule V
2. Prescription Drugs
3. Nonprescription
medications known as
over the counter
4. Alternative
1 Narcotic Precautions
2. Personnel negligence
a. A much lower level of abuse than the other schedule levels.
b. These substances are accepted for use in treatment of diseases and
c. May lead to minimal physical and psychological dependence.
Examples: Cough syrup Promethazine with codeine, lomotil
Pseudoephedrine which is found in many antihistamines was used
inappropriately by drug users so the federal government has regulated
pseudoephedrine by making it necessary for the consumer to sign a registry
and give valid photo ID before they can purchase any medication
containing pseudoephedrine
Drugs that require a physician prescription so that the directions of how to
take specifically for each person is available.
The prescription includes the patient’s name, MD’s name, type of
medication, dosage, route of administration and timing of the medication
a. Anyone can purchase the medication from a shelf. Direction for usage
are printed on the box or an information sheet inside the box.
b. Many of these drugs were prescription drugs released by the FDA after
significant use and monitoring. FDA feels that they are safe for use as an
over the counter medication
a. Homeopathic remedies
b. Herbal remedies
These are for the individual to determine the method of treatment they
wish to take.
Medication /Solution Violations
a. Narcotics should only be taken under the direction of a physician.
b. They are known for the depression of the central nervous system i.e.
Difficulty breathing
c. Liver damage could present a problem because it may not be able to
detoxify the body of the drugs taken which could result in an overdose.
d. Narcotics obtained from dealers could have toxic chemicals or contain
life-threatening compounds.
a. The staff of any medical facility must know what meds they are given,
dosage of the meds, and the proper route for administration.
b. Not knowing this information could result in the patient receiving wrong
dosages as well as the wrong route. These situations could result in an
overdose and death of the patient.
c. Incorrect drugs or incorrect administration could lead to very serious
implications for the patient and the staff.
Medication /Solution Violations
It is the only way that you will know you are giving the proper medication
at the proper time.
3. Consequences to
1 Healthcare facilities
policies and procedures
2. State regulations can
be obtained at:
Patient can have an adverse reaction to a medication if they should not
receive it especially if they are allergic.
Patient could ultimately die from the wrong dosage or wrong
administration process.
Laws, Policies and Procedures
a. It is your responsibility to find out what the hospital’s policies and
procedures for medication administration are so that you can comply
Federal Laws:
Most of the laws are created under the Food and Drug Act or the Drug
Enforcement Administration. Either of these sites would be able to give
you specific information
3. Types of Medication
a. Standing orders are ongoing orders. They can be found in the operating
room often times on surgeon’s preference card.
Specific cases may have standing order sheets which are implemented by
sending the order form to pharmacy for the medications and the MD order
form is kept on the patient chart.
b. Stat
Medication that needs to be given immediately.
c. Verbal
MD orders medications by giving a verbal order to an RN.
d. PRN (Pro Re Nata,
Latin for as needed)
This medication is only given as needed such as with pain medications. It
may be ordered but if the patient has no pain then the drug would not be
Common Sources of Information
Most widely used annual reference publication for drugs in current use
Contains information concerning drug actions, indications, warnings, and
precautions, dosages, rout of administration, adverse reactions, overdose,
drug interaction and contraindications
Provides information to physicians
Is used primarily by drug companies and pharmacies
Includes annual up-to-date information on carcinogen
Contains concise information and is easy to read
1. Physician’s Desk
Reference (PDR)
2. United States
Pharmacopoeia and
National Formulary
3. American Hospital
Formulary Service Drug
Information (AHFS)
Is an annual publication
distributes to practicing
5. The Joint
Commission National
Patient Safety Goals
Goals developed by JCAHO to help hospitals provide better care to the
patient. Usually developed because of sentinel events occurring.
1. Plants
Sources of Drugs
Berries, leaves, roots, resin and bark from trees were found to benefit
the body and are still in use today.
2. Minerals
3. Animals
4. Synthetics
Deficiencies of substances in the human body are often replaced with
substance from the glands, organs and tissues of animals
Drugs acquired from cattle are called bovine and those from swine are
called porcine.
Are manufactured by humans and produced from artificial substances
rather than natural substances
Can be manufactured totally from laboratory chemicals or semisynthetic drugs
Can be activated with a natural substance rather than altered chemically
5. Biotechnology
Genetic engineering (recombinant DNA technology) is the newest
technology being used to synthetically mass produce previously rare and
expensive drugs. By introducing un related DNA into the DNA of specific
organisms, DNA can be artificially created.
A distinctive pattern of bands which aid in the identification of the
origin of tissue and body fluids.
Types of Drug
Absorbed through the alimentary tract
• Routes of administration can be oral, buccal, or sublingual
1. Solids
2. Semi-solids
Are meant to have a topical or systemic effect
• Can be applied directly to skin or mucous membranes to produce the
desired effect
3. Liquids
Contain drugs that are dissolved in a base
a. Suspension
a. Fine, undissolved solid particles of a drug suspended with a liquid
b. Emulsion
b. A mixture of two liquids not mutually soluble, such as fat and water
c. Solution
c. A liquid drug containing a dissolved substance
d. Tincture
d. A solution that contains an alcohol and water base; used topically
e. Elixir
e. A sweetened, aromatic solution with an alcohol and water base
f. Syrup
f. A concentrated solution of sugar, water, and flavoring which contains
no alcohol
g. Liquid sprays
g. A solution of a drug containing water or alcohol administered as an
aerosol or spray
h. A mixture of finely divided gas bubbles interspersed in a liquid
h. Foam
4. Gases
Are introduced into the respiratory tract to provide a systemic effect
Route of Administration of Drugs
1. Oral
Administered through the mouth into gastrointestinal tract
2. Buccal
Places between the cheek and the gums until absorbed or dissolved
3. Sublingual
Placed under the tongue until the drug has been absorbed or dissolved
Applied directly to the skin, mucous membranes of the eyes, ears, nose
or mouth, or on surface of structures in an open surgical wound
Administered via the rectum
4. Topical
5. Rectal
Used for the application of creams and suppositories
6. Vaginal
Applied directly to the skin via a porous membrane for a systemic effect
7. Transdermal
8. Inhalation
9. Subcutaneous
Involves inhaling a drug in the form of a gas or liquid into the alveoli of
the lung
Involves injection of medication into the fatty layer of tissue directly
below the dermis of the skin
Involves injection of a liquid directly into the muscle
10. Intramuscular
11. Intravenous
Involves injection of liquid medication directly into a vein to produce a
systemic effect
Involves injection of a liquid into a joint in the body
12. Intra-articular
Involves injection of medication directly into the heart
13. Intracardiac
14. Intrathecal
15. Instillation
Involves the injection of medication into the subarachnoid space of the
spinal canal
The slow introduction of fluid or medication into a cavity or part of the
body which remains there for a specific length of time before being
drained or withdrawn
Drugs absorbed through the intestines
16. Enteral
1. Analgesic
Classification of agents
Selectively suppresses pain without producing sedation
2. Analgesic-Antipyretic
3. Anticoagulants
Selectively suppresses pain and also has a fever reducing component to
Prevents the formation of blood clots by inhibiting one or several
clotting factors
4. Anticonvulsants
Reduces the number or severity of seizures in patients with epilepsy
5. Antiemetics
Drugs that helps to stop nausea and vomiting
6. Antihistamine
Blocks the effect of histamine release in an allergic reaction
7. Antibiotics, Antiinfectives
Destroys bacteria and other pathogenic microorganisms
a. Aminoglycosides
a. Drugs made from molecule or a portion of a molecule composed of
amino-modified sugars.
Amikacin, arbekacin, gentamycin, knanmycin, neomycin, netilmicin,
paromomycin, rhodostreptomycin, streptomycin, tobramycin and
b. Antifungals
b. Medication used to treat fungal infections such as ringworm, athletes
foot, thrush and crytococcus meningitis
c. Antimicrobial
c. Medication that is used to kill or inhibit the growth of microorganisms
(Penicillin and tetracycline
d. Penicillin/
d. One of the first antibiotics developed to treat bacteria especially
gram-positive organism
e. Polymyxins
e. These drugs disrupt the structure of the bacterial cell membrane by
interacting with the bacteria’s phospholipids. They work on grampositive bacteria. Polysporin, neosporin, polymyxin B or M.
f. Sulfonamides
g. Tetracycline
f. These are sulfa drugs commonly used for urinary infections
g. Are broad spectrum antibiotics; have a bacteriostatic action against
many gram + and gram – bacteria
Can be administered orally, topically, occasionally IM or IV
8. Antineoplastic
9. Autonomic agents
a. Adrenergics
Prevents the development, growth, or proliferation of malignant or
cancerous cells
b. Adrenergic blockers
b. Blocks the secretion of epinephrine from the sympathetic nervous
c. Cholinergics
c. Stimulate parasympathetic nervous system in same manner as does
May stimulate cholinergic receptors directly or slow acetylcholine
metabolism at synapses (affect the enzyme acetylcholinesterase)
Useful in treating Alzheimer’s Disease, Myasthenia gravis and to treat
poor muscle tone of the smooth muscle of the GI system or urinary
d. Anticholinergics
d. Inhibits the parasympathetic response by manifesting the drying up of
body secretions
a. Imitates the action of the sympathetic nervous system by stimulating
nerve fibers to release epinephrine
10. Blood Replacement
a. Autologous blood
b. Donated blood products
c. Whole Blood
d. Plasma Expanders
11. Cardiac Medications
a. Antiarrhythmias
This is to prevent the need for blood bank blood during a surgery
Self pre-donated blood prior to surgery
Saved during surgery by a cellsaver and then reinfused to the patient
1. type and cross match
Check of patient’s blood for the purpose of matching blood type
to other people’s blood
2. Component therapy
Blood can be separated into several different components.
Blood can be given as whole blood
Blood can be divided into plasma, packed cells, platelets
c. All parts of the blood are given at one time
d. Used for Circulatory Shock situations
1. Crystalloids and Colloids
a. Common Crystalloids used are normal saline (0.9% NaCl) or
lactated Ringer's solution.
b. Common Colloids include Albumin (found in blood), Dextran,
Hyskon, Getran, Plasbumin
Hetastarch (Hespan®) is also a common volume expander made of
 Lidocaine Hydrochloride (Xylocaine)
Effect the heart through the Purkinje Fibers by decreasing the
depolarization and excitement
Used mostly for ventricular anomalies or arrhythmia
 Pronestyl or procainamide
Works through decreasing excitability and conduction in the
hearts conduction system
Used for ventricular anomalies and arrythmias
Used for patients with angina symptoms due to myocardial
Helps to increase coronary artery flow so the heart gets its
nourishment by decreasing systemic vascular resistance
They help to increase muscle contraction strength of the heart
Digitalis which is derived from the plant foxglove helps to make
the muscle work better.
It is not curative but will help to prolong a person’s life
Other agents that could be used for heart failure conditions:
Amrinone (Inocor®)
Digitoxin (Crystodigin®)
Digoxin (Lanoxin®, Lanoxicaps®)
Dobutamine (Dobutrex®)
Milrinone (Primacor®)
b. Coronary Dilators
c. Inotropic
12. Central Nervous
System Stimulants
a. Analeptics
a. An agent that works to stimulate a depressed nervous system
They increase attention and decrease restlessness and can often
enhance coordination
Used to treat attention deficit hyperactivity disorder and narcolepsy
Examples: Doxapram, caffeine, amphetamines, dextroamphetamines
b. Emetics
b. Drugs that induce vomiting.
Used when consumption of a toxic substance needs to be removed
Ipecac used to be used for inducing vomiting but it no longer
Apomorphine, Xylazine and hydrogen peroxide
c. Neuroleptics
c. Drug that is used to calm down a patient with a psychotic condition
A tranquilizer
Examples: Thorazine, Haldol, Clozaril, lithium carbonate, Loxatane
Drugs and agents that are used to control bleeding and hemorrhage by
creating clotting
13. Coagulants and
a. Absorbable gelatin
which is made of collagen
b. Collagen
a. It is either in the form of a powder, foam or film
These items are soaked in thrombin, epinephrine, or saline. It can be left
in the body postoperatively and will be absorbed by the body in 30 days
b. It is available in a number of forms but it is absorbed by the body.
It must be applied dry because it will become sticky if it gets wet and
will not work properly
Example: Avitene which is powder, sheets and preloaded applicators
c. Oxidized cellulose
c. These are usually in the form of a gauze or pad
It is placed on an area of bleeding and it creates a gel as it gets soaked
with blood.
It is kept in place until bleeding stops and then removed
d. Silver Nitrate
d. It is used for small areas of bleeding. Usually an applicator but could
be in other forms
Common Drugs used in Surgery
e. Epinephrine
e. Mixed with a local anesthetic and it becomes a vasoconstrictor
It is absorbed rapidly by the body but provided good localized
f. Thrombin
f. Topical hemostatic agent that can be poured directly on a bleeding
area but is usually used in concert with other hemostatic agents such as
14. Contrast Media
a. Radiopaque dyes used to outline various anatomical structures
through x-ray
b. Are commonly used in biliary surgery to determine the presence of
stones which appear as dark spots against the white contrast media
c. Are commonly used in cardiovascular and gastrointestinal surgery to
identify strictures
d. Syringes and containers containing contrast media on the sterile field
must be labeled to prevent medication error.
e. Patients must be checked for allergies to iodine prior to
administration of contrast media.
f. Common contrast media include:
Diatrizoate sodium (Hypaque®, Renografin®, Conroy®) are used for
radiography of the biliary tract, kidney, and other internal strictures.
Diatrizoate meglumine (Cystografin®) is used for radiography of the
urinary tract.
Iohexol (Omnipaque®) is used for radiography of the female
reproductive organs and for viewing body structures such as the brain,
spinal cord, liver, pancreas, kidneys, aorta and blood vessels
Key Term
Impenetrable (solid) to x-rays or other forms of radiation
15. Diuretics
a. Are used to prevent reabsorption of Na. and H2O by the kidneys
b. Draw fluids from the tissues and into the urinary system
c. In surgery, diuretics are commonly used to reduce intraocular or
intracranial pressure.
d. Adverse effects of use include hypokalemia.
e. Diuretics commonly used in surgery include:
Mannitol (Osmitrol®) is the most common osmotic diuretic used to
provide a rapid reduction in intraocular pressure in patients with
glaucoma and used in neurosurgery to reduce cerebral edema
Furosemide (Lasix®) decrease intracranial pressure by quickly removing
fluids that have accumulated because of a head trauma or an
intracranial surgical procedure
An abnormally low concentration of K+ in the blood
16. Dyes
a. Are used in surgery to mark skin incision lines and in diagnostic
procedures to determine if internal structures are patent (open)
b. Are applied to the skin by using a cotton-tipped applicator or by
using a manufactured skin marking pen
c. Common dyes include:
Methylene blue
Used for staining and to determine fallopian tube patency
Indigo carmine
Can be administered IV to color urine for evidence of bladder and kidney
functions; may also be used for tracking fissures, fistulas, and
determining the patency of fallopian tubes
Gentian violet
Purple dye used frequently in surgery to mark skin incision; should
NEVER be injected
Lugol’s solution
Used to stain cervical cancer
Acetic acid (vinegar)
A colored staining agent used to ID areas of cervical dysplasia
17. Emergency Drugs
a. Malignant Hyperthermia
Genetically transmitted disease
It is more common in men than women
Initial symptoms are unexplained tachycardia, increased levels of carbon
dioxide, hypertension, muscle contractions, perspiration and cyanosis.
A late sign is significant increase in temperature to as high as 107o to
Treatment of malignant hyperthermia is to stop the anesthetic that
causes the situation. It is usually succinylcholine.
Administration of Dantrolene and the infusion of chilled IV fluids
a. Aminophylline or
2. Cardiac arrest and respiratory arrest drugs
a. A spasmolytic that is used to treat acute and chronic bronchial
asthma, bronchospasms, pulmonary emphysema, Cheyne-Stokes
respirations, and pulmonary edema
b. Atropine sulfate
b. An anticholinergic drug used to treat bradycardia and
bradyarrhythmia; also administered preoperatively to dry up oral
c. Calcium Chloride
c. An electrolyte replacement given to increase the force of the
myocardial contraction
d. Dantrolene®
d. A muscle relaxant given for the treatment of malignant hyperthermia
Drugs used for Emergency Situations
e. Digoxin (Lanoxin®)
e. A drug that acts directly on the myocardium; used to treat congestive
heart failure, atrial tachycardia, and atrial fibrillation and flutter; slows
the heart rate and strengthens contractions
f. Diphenhydramine
hydrochloride (Benadryl®)
f. A sedating antihistamine used with epinephrine to treat anaphylaxis
g. Epinephrine
g. An adrenergic used as a vasoconstrictor, as a cardiac stimulant, and
to relax bronchioles; used to treat anaphylactic reactions, asthmatic
attacks, and local hemorrhaging; also used to prolong the action of local
anesthetic agents
h. Lidocaine hydrochloride
h. An antiarrhythmic used to treat premature ventricular contractions
(PVCs), ventricular arrhythmias, or ventricular tachycardia; also used as
a local anesthetic agent
i. Norepinephrine injection
i. An adrenergic used to restore blood pressure in acute hypotensive
j. Papaverine®
j. A vasodilator drug used to dilate small vessels for surgical procedures
such as AV shunts, fistulas, or femoral-popliteal bypasses
k. Potassium
k. An electrolyte which can cause a cardiac irritability if a deficiency is
l. Sodium bicarbonate
l. An alkalinizer used to treat metabolic acidosis, especially during a
cardiac arrest
m. Verapamil
m. A calcium blocker used to treat arrhythmias and angina
18. Gastric medications
Stops or prevents spasms
a. H2-receptor blockers
Are acid reducing medications for GERD or acid reflux
Examples of medications: Pepcid, Tagament, cimetadine, Zantax
19. Hormones
a. Prostaglandin
(hormones produced by
the pituitary gland
a. Are used to stimulate the uterus to contract during labor
Are used in surgery to expel uterine contents (blood clots, placenta
remnants) after a C-section or a therapeutic abortion
Commonly used oxytocics include synthetic oxytocin Oxytocin®,
Pitocin®, & Syntocinon®) and methylergonovine maleate (Methergine®)
b. Sex Hormones
(Hormones produced by
the ovaries)
b. Estrogen and progesterone are used in replacement therapy after
surgical removal of ovaries
Estrogen is available in a cream form which can be applied to vaginal
packing placed after a vaginal hysterectomy
c. Hormones produced by
the pancreas
c. Regulate the metabolism of glucose, a simple sugar used as an energy
Glucagon stimulates the liver to break down glycogen in glucose which
then increases blood sugar levels.
Insulin stimulates the liver to form glycogen from glucose which then
lowers blood sugar levels.
Insulin may be administered during a surgical procedure to decrease an
elevated blood sugar level in a diabetic patient
d. Corticosteroid
d. Drugs in this category include cortisone, hydrocortisone and
They are often utilized for the treatment of a variety of conditions, such
as rashes, asthma and lupus. But corticosteroids also carry a risk of side
Steroid need to build up in the system and can cause side effects.
A person needs to be weaned off of these medications in order to
prevent ill effects.
Are commonly used in surgery to reduce tissue inflammation and
postoperative swelling
Are particularly useful in ophthalmic and orthopedic surgical procedures
Can be administered orally, topically, IM or IV
Common synthetic steroids include hydrocortisone (Hydrocortone®,
Cortisol®, Solu-Cortef®) prednisone, methylprednisolone (Medrol®,
Depo-Medrol®, Solu-medrol®)®®®®®
Triacinolone acetonide (Aristocort®, Kenelog 40®, Kenacort®)
dexamethasone (Decadron®), and betamethasone (Celestone®).
20. Inhalants
a. Nasal spray
b. Respiratory inhalers
21. Irrigation Solutions
a. Dextran
Artificially prepared or made
A. Decongestants used prior to nasal surgery.
Neosynephrine spray
Afrin Spray
b. Pass to the circulatory system through the respiratory system
a. – artificial plasma-volume expander. It is great in hypovolemic shock
from hemorrhage
b. hetastarch (Hespan)
b. Plasma expander in emergency situations
Not to be given to patients with severe oliguria and hypervolemia
c. Dextrose in a water or
saline solution
c. is used for patients requiring an easily metabolized source of calories.
d. Lactated Ringers
d. Is a physiologic salt solution that may be used to replenish the
patient’s supply of electrolytes to improve circulation, or to stimulate
renal activity
e. Plasmalyte® and Isolyte
e. Are electrolyte balanced solutions which are compatible with the pH
of blood. They are used to treat massive fluid and electrolyte loss
f. Sodium Chloride
f. Normal fluid replacement and fluid maintenance
Used also for topical irrigation
g. Sorbitol
g. Used during GU surgery when cautery is being utilized
22. Intravenous Solutions
1. Most patients scheduled for surgery will receive an IV solution when
they come to the OR
2. IV fluids are given intraoperatively to restore blood volume and
replace fluids lost during the surgical procedure
3. The IV route allows the surgical team, particularly the
anesthesiologist, a convenient and efficient for administering drugs and
anesthesia agents as well as blood replacements and substitutes if
4. Common IV solutions include:
Normal saline is the most common
(Normal saline for IV is different than irrigating normal saline because of
their packaging. Irrigation should never be instilled via IV. When
making heparin solutions on the field it needs to be mixed with IV saline
not irrigating saline
Dextrose in a water or saline solution is used for patients requiring an
easily metabolized source of calories.
Lactated Ringer’s solution is a physiologic salt solution that may be used
to replenish the patient’s supply of electrolytes to improve circulation,
or to stimulate renal activity
Plasmalyte® and Isolyte E® are electrolyte balanced solutions which are
compatible with the pH of blood. They are used to treat massive fluid
and electrolyte loss
23. Narcotic
1. Are primarily used to relieve pain Pre-, Intra- and Postoperatively
2. Are capable of causing dependence with regular use
3. Are classified as controlled substances by the federal government
4. Special caution is required when handling controlled substances in
the OR. They must be in a locked cabinet per the Drug Enforcement
Agency (DEA)
5. Adverse effects to narcotics include nausea, vomiting, resp
depression, and reduced intestinal motility
6. Narcotic antagonists such as naloxone (Narcan®) should be on hand to
reverse the depressant effects of narcotics if needed.
7. Common narcotics used in Surgery:
Morphine sulfate
Very potent, addictive narcotic that raises the pain threshold, produces
sedation, and depresses respirations
Meperidine hydrochloride (Demerol®)
Most common synthetic narcotic used for preoperative injections and
postoperative pain; used as a substitute for morphine sulfate because it
does not depress respirations as morphine does
Fentanyl citrate (Sublimaze®)
Used as an adjunct to general anesthesia to relieve pain and produce
sedation; 100 times more potent than morphine; commonly used in
short surgical procedures and as a preoperative and postoperative
medication because of its short duration
Alfentanil (Alfenta®) – Ultra-short acting narcotic agents; has a slow
onset lasting only about 10-15 minutes
Sufentanil (Sufenta®) – Used to maintain a balance general anesthesia;
5-10 times more potent than fentanyl but is rapidly but is rapidly
absorbed by the body to provide a rapid recovery; its effects last
between 20-45 minutes
Cocaine hydrochloride – Used in surgery to shrink mucous membranes
and to reduce bleeding in the nose; administered topically and NEVER
injected due to its high toxicity
24. Narcotic Antagonist
A substance that counteracts the action of something else
a. Romazicon
a. Complete or partial reversal of sedative effects of benzodiazepines
after anesthesia or conscious sedation
b. Narcan
b. Used for opioid narcotic overdose or narcotic depression
25. Obstetrical
a. Oxytocin (Pitocin)
b. RhoGAM
26. Ophthalmic Surgery
a. Anesthetic agents
a. Utilized to induce or stimulate labor
Facilitates the contraction of the uterus even for spontaneous abortions
b. RHo (D) immune globulin is used to prevent an immune response to
Rh positive blood in people with an Rh negative blood type.
a. Used locally or topically to produce the absence of all sensation.
Xylocaine®, Marcaine®, Sensorcaine®, Ophthaine®, and Pontocaine®
b. Antibiotics
b. Used to prevent or treat infections; may be administered topically, or
by an injection, but usually are administered by topical drops or
c. Irrigants
c. Used to irrigate the anterior chamber to keep the cornea and eye
tissue moist and to soak and rinse intraocular lenses
Balanced salt solution (BSS), A-K Rinse®, Blinx®, and Irigate®
d. Miotics
d. Constrict the pupil to reduce intraocular pressure; also are used to
help prevent the loss of vitreous humor in cataract surgery; are
administered in a drop form
Carbachol (IsoptoCarbachol®), Miostat®, and pilocarpine hydrochloride
(Pilocar®, Isorocarpine®), Miostat® is unstable in solution and should not
be used after sitting for 15 minutes. Therefore, it should be prepared
immediately before use.
e. Mydriatics/Cycloplegics
e. Paralytic agents used to dilate the pupil prior to ophthamoscopy;
administered by drop form
Common mydriatics include atropine and phenylephrine
(NeoSynephrine®); common cycloplegics include Cyclogyl® and
f. Enzymes
f. Proteins that act as a catalyst to speed up chemical reactions.
Hyalinidase (Wydase®) and alpha-chymotrypsin (Alpha-Chymar®,
The loss of sensation or movement
Enzyme used to dissolve the suspensory ligament in order to facilitate
the removal of the cataract lens
g. Dyes and Stains
g. Visionblue® is a staining solution for cataract surgery. It is used to
stain the anterior lens capsule so that the capsule is completely
removed during surgery.
Membraneblue allows surgeons to clearly differentiate the layers of the
retina. May reduce the risk of long-term complications, such as
recurrent Posterior vitreous detachment.
Fluorescein eye stain
This is a test that uses orange dye (fluorescein) and a blue light to detect
foreign bodies in the eye. This test can also detect damage to the
cornea, the outer surface of the eye.
h. Lubricants
h. Eye drops and ointments are used to keep the eyes lubricated and
free from injury during surgery. Prevent dryness and scratching of the
i. Viscoelastics
i. Utilized to keep the anterior chamber from collapsing after the
incision is made for cataract surgery
Discovisc, Viscoat, Provisc, Duovisc, Cellugel Healon, Amvisc, Ocucoat
27. Sedative Hypnotics
a. Versed midazolam
a. Given as sedation before general anesthesia induction as well as for
conscious sedation. Do not give to patients with glaucoma, shock, coma
and acute alcohol intoxication
b. Nebutol pentobarbital
b. Sedative and hypnotic given as a preanesthetic medication for the
induction of general anesthesia
c. Luminol phenobarbitol
c. Utilized on pediatric patients for preoperative and postoperative
d. Seconal Sodium secobarbitol sodium
d. Given preoperatively to provide basal hypnosis for general, spinal or
regional anesthesia
28. Tranquilizers
a. (Valium) diazepam
a. Used to allay anxiety and tension in the patient prior to surgery,
preoperative sedative
b. (Inapsine) droperidol
b. Used for tranquilizing effect as well as an antiemetic to control
nausea and vomiting. It is also a general anesthesia enhancement
medication ie. Maintenance.
c. (Vistaril) hydroxyzine
c. Reduces anxiety and tension preoperatively and helps to reduce the
need for narcotics. Also has an antiemetic effect to help control nausea
and vomiting
d. Utilized for sedation and anxiety reduction preoperatively
Alternative medications
1. Homeopathic remedies help to stimulate the body’s own defenses
and are based on items from nature. They do not cause side effects
d. (Ativan) Iorazepam
1. Herbal medicines
because they help to keep the body balanced
2. Nutritional supplements 2. A preparation that is intended to help support the person’s
nutritional status. Items such as vitamins, minerals, fiber and amino
Care and Handling of Medications
1. It is the surgical technologist's responsibility to be aware of local, state, and federal regulations
concerning drugs and their administration.
2. The role of the surgical technologist in the handling of drugs should be addressed in each
institution's policy and procedure manual. Policies and procedures may vary from facility to facility so
it is the surgical technologist's responsibility to become familiar with medication administration
policies of their facility.
3. Only a registered nurse or physician can legally distribute medications to a surgical technologist. A
verbal order from the physician for the distribution of a medication can only be taken by the nurse.
4. The surgical technologist is responsible for receiving, preparing, mixing, and labeling all drugs on
the sterile back table after properly cross-referencing with the circulator.
5. The surgical technologist NEVER administers medications to patient. However, they will be involved
in the preparation and handling of medication during a surgical procedure.
6. Medication should NEVER be accepted from vials that are cracked or chipped.
7. Medication should NEVER be accepted if it appears discolored or suspicious.
8. NEVER use a drug if you are in doubt about the identification of the drug.
9. Do not accept a medication from a vial or bottle you have not identified. If the medications are not
clearly identified, they must be discarded and new medications obtained.
10. Immediately label all medications, both container and syringes, on the sterile back table, by using
a sterile marking pen or by another acceptable method.
11. Inadequate or improper labeling on the sterile field may be considered negligent.
12. NEVER use outdated medications. The composition and effect of the drug may be altered
13. It is the responsibility of both the circulating nurse and the surgical technologist to make certain
that the correct drug, correct amount, and the correct strength are administered.
14. Keep track of the amount of medication being used on the sterile field.
15. Keep track of how much irrigation solution is used within the wound so that blood loss can be
Procedure for Surgical Technologist to Accept Medications
1. The principle of aseptic technique must be strictly followed when delivering and
receiving medication onto the sterile field.
2. Identifying medication to be used on the sterile field is both the circulator and surgical
technologist's responsibility. This dual responsibility reduces the potential for medication errors.
3. Important information about the drug must be identified on the medication label such as name,
strength, amount, and expiration date.
4. The circulator obtains the medication and checks the integrity of container for cracks or discolored
contents. The nurse shows the bottle to the surgical technologist.
5. The circulator reads the label aloud prior to delivering the medication to the sterile field.
6. The surgical technologist recites aloud the drug's name, amount, strength, and the expiration date.
7. The circulator distributes the drug to the surgical technologist into a sterile medicine cup or basin
while maintaining aseptic technique.
8. The circulator shows the medication vial to the surgical technologist again.
9. The surgical technologist immediately labels the medication with the name and strength of the
drug. The circulator leaves the empty medication bottle in the room until the completion of the
procedure to confirm the medication if necessary
10. Once the medication is on the sterile field, It Is the surgical technologist's responsibility to pass the
correct medication in the strength specified by the surgeon.
11. The surgical technologist is responsible for informing the surgeon of all medication and mixtures
as the drug is passed intraoperatively. The surgical technologist should state the kind and percentage
of the medication as he or she is passing the medication to the surgeon.
12. It is the surgical technologist's responsibility to remember the amount of medication used on the
sterile field
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