MEDICATION HANDLINGANES 1501

INTRODUCTION TO ANESTHESIA TECHNOLOGY

COLLEGE OF DUPAGE

DRUG A substance used as medicine for the diagnosis, treatment, cure, mitigation, or prevention (prophylaxis) of disease or a condition

Drugs are derived from 5 main sources

DRUG SOURCES Plants - Morphine and digitalis

Animals – primarily hormones – heparin sodium and thrombin. Drugs obtained from cows=bovine, porcine=pigs

Minerals – from the earth-calcium, iron, magnesium, gold, silver, zinc

Other Drug Sources Laboratory synthesis – majority of drugs used today Synthetic drugs – manufactured totally from laboratory chemicals, ie-Demerol

Semisynthetic – begins with a natural substance, which is then chemically altered, ie-the aminogylcoside group of antibiotics.

Biotechnology – genetic engineering, ie-hepatitis B vaccine. New technology is referred to as recombinant technology.

DRUG PROPERTIES PRARMACODYNAMICS

The interaction of drug molecules with the target cells of living tissue. The resulting action is both biochemical and physiological

Medication action – drug interaction may be intentional (beneficial) or undesirable (detrimental)

MEDICATION EFFECTS Therapeutic effect- the concentration or dose of a medication used to produce the desired result without producing harmful effect.

Side effect – an expected, undesirable but tolerable effect of a medication. These include symptoms such as dry mouth, constipation, diarrhea, etc.

MEDICATION EFFECTS Adverse effect – undesirable and potentially harmful effect of a medication that can lead to organ damage or failure. Susceptible organs include the brain, liver, kidneys and CV system.

Toxic effect – the undesirable and unacceptable effects of a medication. The effects can include the promotion of growth of cancerous tumors or the development of birth defects

MEDICATION EFFECTS Tolerance – 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 effect.

Addiction – a physical or psychological dependency on the effects of medication.

DRUG STANDARDS Medication for use in the US are required to undergo review and approval by the FDA. Listings and formulas are found in the following publications.

National Formulary – info on single drugs and formulas; drugs are listed by generic names

Pharmacopeia of the US (USP) – info on medications currently used in practices; drug lists by generic names, classifications, & dosages

DRUG STANDARDS American Hospital Formulary Service Index – info arranged in therapeutic or pharmacological class

Physician’s Desk Reference (PDR) – not official listing, commonly used by physicians for prescription; alphabetic by brand name

LEGAL DRUG CLASSIFICATIONS The 3 legal drug classifications that are most commonly used are controlled substances, prescribed medication, and over-the-counter, they are classified according to their principal action

Controlled substances – those with a high potential to cause psychological and/or physical dependence and abuse

CONTROLLED SUBSTANCES Schedule I–– they have the highest potential for abuse, with no acceptable medical use. Examples: heroin, lysergic acid diethlamide (LSD)

Schedule II –– high potential for abuse, but which there is a current approved medical use. Examples: Fentanyl, Dilaudid, Morphine, Cocaine (topical)

Schedule III – high potential for abuse, less than the drugs or other substances in schedule I or II. Examples Steroids, Ketamine

Schedule IV– low potential for abuse with accepted medial use. Examples: Xanax, Valium, Versed

CONTROLLED SUBSTANCES Schedule V–– they have a low potential for abuse relative to the drugs and other substances in schedule IV and have accepted medicinal use. Examples: Lyrica and cough suppressants with small amount of codeine

PRESCRIBED MEDICATIONS Prescribed medications are those meds that, if used inappropriately could cause significant harm to the patient

OVER-THE-COUNTER OTC meds are pharmacologic agents that are prepared in a dosage generally safe to administer without physician’s direction

MEDICATION INFORMATION The Anesthesia Technologist is responsible for knowing basic info about the meds they handle on the sterile field, including – names, classifications, action, indications, uses in the surgical setting and dosages

MEDICATION NAMES Trade, brand or proprietary – name assigned and copyrighted by the manufacturer

The trade name of the med is capitalized and may be followed by an R with a circle around it.

Generic – nonproprietary, often shortened version of chemical name. Use of the generic name often advocated in health care settings to avoid confusion between medications with similar trade names

Chemical – precise chemical composition and molecular structure

ABBREVIATIONS RELATED TO MEDICATIONS

The Joint Commission recommends that abbreviations no longer be used for the following:

Cubic centimeters micrograms Hour Daily, twice daily, three times daily, every other day Magnesium sulfate morphine sulfate International units units

DRUG HANDLING THECHNIQUES Drug safety is of the utmost concern. Medication errors can be minimized by knowing policies, procedures and pertinent state and federal laws.

6 (not 5) Drug Routes

Six basic rights for correct drug handling• The right patient• The right dose• The right time and frequency• The right documentation, including labeling• The right drug• The right route

MEDICATION IDENTIFICATION Drugs come in different packages – ampule, vial, preloaded syringe, tube.

Label information– name, manufacturer, strength, amount, expiration date, route of administration, lot number, handling/storage.

ASA CLASSIFICATIONS The American Society of Anesthesiologists has set forth a classification system for assessing patient risk, the classes are as follows:

Class 1 – no organic, physiological, biochemical or psychiatric disturbance

Class 2 – mild to moderate systemic disease disturbance, history of asthma, smoker, controlled diabetes, mild obesity, age less than 1 or greater then 70

ASA CLASSIFICATIONS Class 3 – severe systemic disturbance or disease, angina, post-myocardial infarction, poorly controlled hypertension, massive obesity, symptomatic respiratory disease

Class 4 – pt. with severe systemic disease, disorders, that are life threatening, unstable angina, CHF, debilitating respiratory disease, hepatorenal failure.

ASA CLASSIFICATIONS, cont. Class 5 – moribund patient with little chance of survival who is operated on in desperation

Class 6 – brain dead, life support provided, organ procurement intended

Emergency modifier (E) – applies when doing and emergency surgery

DEPTH OF ANESTHESIA Stage I – amnesia stage, begins with initial administration of an anesthetic agent to loss of consciousness

Stage II – consists of the period from the loss of consciousness to the return of regular breathing and loss of the eyelid reflex. This stage is often referred toas the excitement or delirium stage.

DEPTH OF ANESTHESIA, cont. Stage III – consists of the period between the onset of regular breathing and loss of eyelid reflex to the cessation of breathing. This is know as the surgical anesthesia stage

Stage IV – is referred to as the overdosage stage, dilated and nonreactive pupils, cessation of respiration and marked hypotension.

PHASES OF GENERAL ANESTHESIA

Induction phase – induction involves altering the patient’s level of consciousness from the conscious to the unconscious state. Hearing is the last sense to leave.

Maintenance phase – surgical intervention takes place during this phase

PHASES OF GENERAL ANESTHESIA, cont.

Emergence phase – occurs as the surgical intervention is being completed, the goal is to have the patient as awake as possible at the end of the surgery. Restoration of the “gag” reflex.

Recovery phase – the period of time during which the pt returns to the optimum level of consciousness and well being.