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Surgical Pharmacology and Anesthesia Chapter 9 (Nicola)

front 1

What is the study of medications and their actions, including drug origins, properties, and uses

back 1

Pharmacology

front 2

What is defined as a substance used for the diagnosis, treatment, cure, mitigation, or prevention (prophylaxis) of disease or a condition

back 2

Drug

front 3

Who has approved and standardized for safety, dosage accuracy, and effectiveness after undergoing several phases of formal independent testing.

back 3

FDA

front 4

What refers to an agent that stimulates or prolongs the response of a drug or a physiologic action

back 4

agonist

front 5

What is lack of recall

back 5

amnesia

front 6

What is an immediate hypersensitivity reaction to a foreign protein or other specific substance

back 6

anaphylaxis

front 7

What is an absence of sensation

back 7

anesthesia

front 8

What refers to an agent used to block the action of another drug or physiological action without producing any effect of its own

back 8

antagonist

front 9

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

back 9

antimuscarinic/anticholingergic

front 10

What is the pulse taken at the apex of the heart

back 10

apical pulse

front 11

What is drawing in or out by suction

back 11

aspiration

front 12

What is the making of drugs in the laboratory using genetic engineering; also referred to as recombinant DNA technology

back 12

biotechnology

front 13

What is the name for a reason why a specific procedure or drug may be undesirable or improper in a particular situation

back 13

contraindication

front 14

What is an ultrasonic device used to identify and assess vascular status of peripheral arteries and veins by magnifying the sound of the blood moving through the vessel

back 14

Doppler

front 15

What is the nonproprietary name for a drug that is often a shortened version of the chemical name and may include a reference to the intended use

back 15

generic

front 16

What is the reactions in the body that act and counteract to maintain the body in a normal physiological state

back 16

homeostasis

front 17

What is the altered state of consciousness that may be achieved by suggestion of another, an individual’s own concentration, or with the use of a substance

back 17

hypnosis

front 18

What is a reason to perform a specific procedure or prescribe a certain drug

back 18

indication

front 19

What is the second phase of general anesthesia, in which the patient is given induction drugs and intubated

back 19

induction

front 20

What is the name for within a joint

back 20

intra-articular

front 21

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

back 21

laryngospasm

front 22

What is the acronym for
Nothing by mouth; Latin acronym for nil per os

back 22

NPO

front 23

What is taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.

back 23

parenteral

front 24

What is the interaction of drug molecules with target cells, resulting in biochemical and physiological actions

back 24

pharmacodynamics

front 25

What is the name for behind the eyeball or pons

back 25

retrobulbar

front 26

What agent produces a soothing or quieting effect but does not cause the person to sleep

back 26

sedative

front 27

What (as pertaining to anesthesia) is an agent that is applied to the surface of the skin or anatomical structure (such as the eye) to produce a loss of feeling or sensation in the area of application; blocks the nerve conduction of superficial nerves

back 27

topical

front 28

What is a group of liquids that easily evaporate and, when inhaled, produce general anesthesia through interaction with the CNS

back 28

volatile agents

front 29

What is the drug source:
morphine sulfate
digitalis

back 29

Plants
At one time, the majority of drugs originated from plants; a number of plant-based medications still in use today

front 30

What is the drug source:
heparin sodium
thrombin

back 30

Animals
Nonsynthetic hormones are derived from animal sources, including human sources; drugs obtained from cows are referred to as bovine and those from pigs as porcine

front 31

What is the drug source:
calcium
iron
magnesium
zinc

back 31

Minerals
Derived from the earth, minerals, and mineral salts

front 32

What is the drug source:
meperidine sulfate (Demerol)
aminoglycoside
antibiotics

back 32

Laboratory synthesis
The majority of drugs used today are manufactured in the laboratory

front 33

What is the drug source:
A process known as genetic engineering hepatitis B vaccine

back 33

Biotechnology (laboratory)or recombinant DNA technology

front 34

What are drugs that are manufactured totally from laboratory chemicals

back 34

Synthetic drugs

front 35

What are drugs that are natural substances that are chemically altered

back 35

Semi-synthetic drugs

front 36

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

back 36

Pharmacodynamics

front 37

What is the drug source:
What technology artificially introduces foreign DNA into the DNA of a specific organism; the two types of DNA combine and the new DNA and its specific protein are replicated in the daughter cells of the organism

back 37

Recombinant DNA

front 38

What is the study of the movement of drugs through the body, involving absorption, distribution, biotransformation, and excretion

back 38

Pharmacokinetics

front 39

What may be intentional (beneficial) or undesirable (detrimental)

back 39

Types of drug interactions

front 40

What can occur when two substances are prescribed concurrently, causing a modification of the action of one or both drugs.

back 40

Drug interactions

front 41

One causes an action, and one blocks the action of the causing the opposite action of the first.

back 41

Agonists vs Antagonists

front 42

What occurs when a drug enhances the effect of another substance. by binding to a specific receptor site in the body, producing an alteration in biological function

back 42

Agonists

front 43

What are two examples of agonists

back 43

Synergists and additives are

front 44

What agent acts in combination to produce a stronger or more powerful effect than would be demonstrated if each agent was administered individually, the action of one agent increases the action of the other agent when delivered together

back 44

Synergistic Agents

front 45

The use of midazolam (a sedative) and fentanyl (a narcotic analgesic) permits the use of lower concentrations of volatile gases during the administration of general inhalation anesthesia is an example of what?

back 45

Example of synergistic agent

front 46

Medication ........ alter some aspect of the action of the original agent.

back 46

Additive Agents

front 47

The addition of epinephrine to the local anesthetic lidocaine to prolong the anesthetic action is an example of what?

back 47

An example of an additive

front 48

What binds to the agonist’s receptor site, preventing the agonist from binding there and causing its desired effect. This results in an absence of the agonist’s action, referred to as agonist reversal.

back 48

Antagonists

front 49

This interaction is demonstrated when flumazinil Mazicon®) is given to reverse the sedative effects of midazolam HCl (Versed®)is an example of what?

back 49

An example of an antagonist

front 50

What action of a a medication describes the application or situation for which the medication is used and the timing of the effects commonly associated with a given medication and dosage.

back 50

Therapeutic action

front 51

What is listing of the medical conditions that the medication is known to treat. The dosage, and delivery form may vary according to the patient’s medical condition, weight, and age

back 51

Indication

front 52

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

back 52

contraindications

front 53

What is the period of time required for the effects of the medication to begin to be demonstrated in the patient

back 53

Onset

front 54

What is the period of time when the maximum effect(s) of the medication are demonstrated in the patient.

back 54

Peak Effect

front 55

What is the overall period of time when the effects of a medication are demonstrated in the patient.

back 55

Duration

front 56

The concentration or dose of a medication used to produce the desired result without producing harmful effects is referred to as the medications ....

back 56

Therapeutic effect

front 57

An expected, undesirable, but tolerable effect of a medication. These can include symptoms such as dry mouth, constipation, diarrhea, dizziness or drowsiness is referred to as the medications ....

back 57

Side effect

front 58

An undesirable and potentially harmful effect of a medication that can lead to organ damage or failure is referred to as the medications ....

.

back 58

Adverse effect

front 59

An undesirable and unacceptable effect of a medication. The effect can include the promotion of growth of cancerous tumors (carcinogens) or the development of birth defects (teratogens)is referred to as the medications ....

back 59

Toxic effect

front 60

A reduction in the effect of a medication results in an increase in dosage in order to achieve the desired effect is referred to as the medications ....

back 60

Tolerance

front 61

A physical or psychological dependency on the effect of a medication is referred to as the medications ....

back 61

Addiction

front 62

What is the term used to describe the metabolic processing of a drug within the body

back 62

Pharmacokinetics

front 63

What does the processes of pharmacokinetics involve

back 63

absorption, distribution, biotransformation, and excretion.

front 64

1. Absorption occurs at site of administration
2. Drug transferred from higher to lower concentration until both sides of cell membrane is equal

back 64

Absorption via passive transport
Requires no energy

front 65

What is required for a limited number of drugs. An energy source in the form of a cation, such as sodium, is required to carry the substance from an area of lower concentration to one of higher concentration.

back 65

Active Transport

front 66

What can be added to a drug preparation to slow absorption.

back 66

The vasoconstrictor epinephrine

front 67

What is distributed to the target cells for action, to the liver for biotransformation, and to the liver or kidneys for elimination

back 67

Distribution of medication

pharmacokinetics

front 68

What is also affected or limited by plasma protein binding, tissue binding, and certain barriers established by the body

back 68

Placental barrier and the blood–brain barrier.

front 69

What are the steps involved in Pharmacokinetics

back 69

Absorption
Distribution
Metabolism
Excreetion

front 70

What action of a drug most often occurs in the liver, but other tissues, including the intestinal mucosa, lungs, kidneys, and blood plasma, may be involved

back 70

Biotransformation or metabolism
pharmacokinetics

front 71

Several medications are converted to an active substance by the liver, but the main function of the liver in drug metabolism is to break down the drug molecules in preparation for excretion.

back 71

Biotransformation or metabolism

pharmacokinetics

front 72

What is the main function of the liver in drug metabolism

back 72

It is to break down the drug molecules in preparation for excretion

pharmacokinetics

front 73

What are the products of metabolic breakdown called

back 73

Metabolites
(They are smaller, inactive substances)

pharmacokinetics

front 74

The effect of medication in the body continues until it is biotransformed and/or excreted. The kidneys are primarily responsible for the filtration of medications from the blood and elimination of medications and metabolites as part of urine formation and excretion. Some medications and metabolites may be eliminated fecally, via sweat or saliva, or exhaled.

back 74

Excretion

pharmacokinetics

front 75

Some medications are eliminated in breast milk, which may affect the breastfed baby

back 75

Excretion

pharmacokinetics

front 76

Placed between the layers of the skin

back 76

Intradermal

Parenteral: Other than through the gastrointestinal tract; by injection

front 77

Subcutaneous (SC or SQ)

back 77

Placed into the adipose (fat) tissue layer under the skin

Parenteral: Other than through the gastrointestinal tract; by injection

front 78

Oral (PO, meaning per os or by mouth)

back 78

Placed in the mouth and swallowed

Enteral: Through the gastrointestinal tract

front 79

Rectal

back 79

Placed into the rectum

Enteral: Through the gastrointestinal tract

front 80

Intramuscular (IM)

back 80

Placed within a muscle

Parenteral: Other than through the gastrointestinal tract; by injection

front 81

Intravenous (IV)

back 81

Placed directly into a vein

Parenteral: Other than through the gastrointestinal tract; by injection

front 82

Intra-articular

back 82

Placed within a joint

Parenteral: Other than through the gastrointestinal tract; by injection

front 83

Intrathecal

back 83

Placed into the subarachnoid space

Parenteral: Other than through the gastrointestinal tract; by injection

front 84

Intracardiac

back 84

Placed into the heart

Parenteral: Other than through the gastrointestinal tract; by injection

front 85

Buccal

back 85

Placed between the cheek and the teeth/gums until it is dissolved and/or absorbed

Topical: Applied to the skin or mucous membrane to provide a localized or systemic effect

front 86

Sublingual

back 86

Placed under the tongue until it is dissolved and/or absorbed

Topical: Applied to the skin or mucous membrane to provide a localized or systemic effect

front 87

Instillation

back 87

Placed in a hollow or cavity, such as the conjunctival fold or bladder

Topical: Applied to the skin or mucous membrane to provide a localized or systemic effect

front 88

Inhalation

back 88

Directly administered to the respiratory tract, usually as a gas or aerosol

Topical: Applied to the skin or mucous membrane to provide a localized or systemic effect

front 89

Which Drug Publication:
Contains information on single drugs and the formulas for drug mixtures; includes drug testing and purity information; lists drugs using generic names; lists medications no longer included in the USP

back 89

National Formulary

front 90

Which Drug Publication:
Contains information on medications used in current medical practice; lists drugs using generic names; includes the medication source, properties, category/classification, dosage range, and therapeutic dosages

back 90

Pharmacopeia of the United States (USP)

front 91

Which Drug Publication:
Presents medical information arranged in therapeutic or pharmacological classes according to generic name

back 91

American Hospital Formulary Service Index

front 92

Which Drug Publication:
Is not an official pharmacological listing, but commonly used by physicians for referencing medications for prescription; medications are listed alphabetically by manufacturer using their brand names

back 92

Physician’s Desk Reference (PDR)

front 93

Which Drug Publication:
Contains The National Patient Safety Goals include policies on “Look-alike/sound-alike medications” and the “Official Do Not Use” abbreviation list

back 93

The Joint Commission National Patient Safety Goals

front 94

Oxygen and nitrous oxide are included in this Forms of Drug Preparation category

back 94

Gas

Forms of Drug Preparation
(Category)

front 95

What is this drug preparation called
Drug (solute) is dissolved in a liquid (solvent)

back 95

Liquid - Solution

Forms of Drug Preparation

front 96

This category has a solution and suspension preparation

back 96

Liquid

Forms of Drug Preparation

front 97

What is this drug preparation called
Solution prepared with water

back 97

Aqueous - Liquid

Forms of Drug Preparation

front 98

What is this drug preparation called
Sweetened aqueous solution

back 98

Syrup - Liquid

Forms of Drug Preparation

front 99

What is this drug preparation called
Solution prepared with alcohol

back 99

Tincture - Liquid

Forms of Drug Preparation

front 100

What is this drug preparation called
Sweetened alcohol solution

back 100

Elixir - Liquid

Form of Drug Preparation

front 101

What is this drug preparation called
Powder —even though it may be in the powdered state, contained within a capsule, or compressed into tablet form—some powders must have liquid added (called reconstitution) prior to use—troches or lozenges also fall into this category

back 101

Solid

Forms of Drug Preparation

front 102

What is a combination of two liquids that cannot mix—droplets of one liquid are dispersed (suspended) throughout the other

back 102

Emulsion

front 103

What is this drug preparation called
Creams, foams, gels, lotions, ointments, and suppositories

back 103

Semisolid

Forms of Drug Preparation

front 104

What are those drugs with a high potential to cause psychological and/or physical dependence and abuse

back 104

Controlled substances

front 105

Controlled Substances - Which Class?
Includes substances for which there is a high abuse potential and no current approved medical use

back 105

Schedule Or Class I
heroin, marijuana, LSD, other hallucinogens, and certain opiates and opium derivatives

front 106

Controlled Substances - Which Class?
Includes substances that have a high abuse potential and a high ability to produce physical and/or psychological dependence and for which there is a current approved or acceptable medical use

back 106

Schedule Or Class II
morphine sulfate, oxycodone, hydromor-phone, meperidine, codeine, anabolic steroids

front 107

Controlled Substances - Which Class?
Includes substances for which there is less potential for abuse than drugs in Schedule II and for which there is a current approved medical use

back 107

Schedule Or Class III
hydrocodone, codeine, and others in combination with other drugs

front 108

Controlled Substances - Which Class?
Includes drugs for which there is a relatively low abuse potential and for which there is a current approved medical use

back 108

Schedule Or Class IV
benzodiazepines (Valium, Ativan)

front 109

Controlled Substances - Which Class?
Drugs in this category consist mainly of preparations containing limited amounts of certain narcotic drugs for use to treat coughing and diarrhea, drugs may be bought without a prescription by an individual at least 18 years of age.

back 109

Schedule Or Class V
cough syrups with codeine; diphenoxylate (Lomotil)

front 110

What medication information does the surgical technologist need in the surgical setting

back 110

names, classifications, actions, indications, uses in the surgical setting, and dosages for use in the surgical setting.

front 111

What is the name assigned to a medication and copyrighted by the manufacturer for marketing. There may be slight differences in the chemical preparation used by each manufacturer, making the preparation under each trade name slightly different

back 111

Trade, brand, or proprietary name
The trade name is prominently displayed on the medication label.

front 112

What is the nonproprietary name for a drug. It is often a shortened version of the chemical name. It may be produced by several manufacturers

back 112

Generic name
The generic name is prominently displayed on the medication label.

front 113

What is the precise chemical composition and molecular structure of the medication, often complex and difficult to use.

back 113

Chemical name
Chemical name is not included on the medication label, but is included in the package insert

front 114

The theory of drug–receptor interaction states that the active substance in the drug has an affinity for a specific chemical constituent of a cell. The interaction occurs on a molecular level with a specific receptor on the cell surface or within the cell to produce the pharmacological response.

back 114

Theory on ways that a drug produces its effect

front 115

The theory of drug–enzyme interaction states that a drug may combine with a specific enzyme to inhibit the action of the enzyme or alter the cellular response to the enzyme

back 115

Theory on ways that a drug produces its effect

front 116

The theory of nonspecific drug interaction, is related to a drug that does not act by either of the two previously described methods and is considered nonspecific in its interaction.

back 116

Theory on ways that a drug produces its effect

front 117

What is commonly expressed in a ratio of medication concentration per kilograms of patient body weight (mg/kg).

back 117

A medication dosage

front 118

What is the ratio of solute to solvent, the two components of a solution (medication)

back 118

The concentration

front 119

What % of sodium chloride is typically needed to reconstitute powder to solvent for injection

back 119

commonly 0.9% sodium chloride

front 120

The dose or dosage is documented in the patient’s record as part of the ........ of medication administration.

back 120

“sixth right”

front 121

What is the term for the medication’s use in the surgical setting

back 121

The application

front 122

What in concentrations of less than 1:100,000, can be injected as a vasoconstrictor, but in concentrations of 1:1,000, it should only be used topically to prevent serious patient complications, including death.

back 122

Epinephrine

front 123

In order to calculate medication dosages on the sterile field, the surgical technologist needs to understand two basic concepts:

back 123

Concentration and cumulative dose

front 124

In order to calculate concentration, you need to convert the solution into units of medications per one unit of fluid; in other words, solute to solvent. This is accomplished using the following formula:

back 124

A : B = C : D

front 125

If the label reads 500 milligrams per 5 milliliters:

back 125

500 : 5 = X : 1 (multiply the means and extremes)
500 = 5X
Reduce the fraction by dividing both sides by “5”
100 = X

front 126

When diluting a medication by adding more solvent to the solute, the concentration changes. For example, when 1 milliliter of heparin sodium 10,000 units per mL is added to 1,000 milliliters of normal saline for injection, the concentration of this medication is 10,000 units per 1,000 mL and needs to be converted using the previous formula

back 126

10,000 : 1,000 = X : 1 (multiply the means by extremes)
10,000 = 1,000X
Reduce the fraction by dividing both sides by “1,000”
10 = X or 10 units per mL

front 127

1 meter = 100 centimeters
1 meter = 1,000 millimeters
1 meter = 1,000 millimeters
1 millimeter = 1,000 microns

back 127

Length
Metric Conversion

front 128

1 millimeter = 1,000 microns
1 gram = 1,000 milligrams
1 gram = 1,000 milligrams
1 milligram = 1,000 micrograms

back 128

Weight
Metric Conversion

front 129

1 milligram = 1,000 micrograms
1 liter = 1,000 milliliters

back 129

Volume
Metric Conversion

front 130

What system do Pharmacists sometimes use.
This system is based on the weight of a grain of wheat. In this system, 12 ounces (rather than the more commonly known 16 ounces) equals one pound. The units of measure are the minim for volume and the grain for weight

back 130

Apothecary system

front 131

Volume
•Minim = m
•Dram = dr
•Drop = gtt
•Ounce = oz
•Pint = pt

back 131

Apothecary system Volume

front 132

•1 meter = approximately 1 yard or 36.37 inches
•2.54 centimeters = 1 inch

back 132

Length
Measurement Equivalents
Apothecary system Volume

front 133

Volume
•1 milliliter = 1 cubic centimeter
•1 fluid ounce = 30 milliliters
•1 gallon = 4 liters or 4000 milliliters
•1 quart = 1,000 milliliters or 1 liter
•1 pint = 500 milliliters

back 133

Volume
Measurement Equivalents
Apothecary system Volume

front 134

Weight
•1 kilogram = 2.2 pounds
•30grams = 1 ounce
•60 milligrams = 1 grain

back 134

Weight
Measurement Equivalents
Apothecary system Volume

front 135

•The “right” patient
•The “right” drug
•The “right” dose
•The “right” route of administration
•The “right” time and frequency
•The “right” documentation, including labeling

back 135

The Six “Rights” of Medication Administration

front 136

What are glass containers that require the top to be broken off to access the contents
Extra caution must be used when handling glass ampules to ensure that glass does not contaminate the medication upon opening the ampule

back 136

Ampule
Medication Identification

front 137

What are plastic or glass container that have a rubber stopper at the top that is held in place with a metal retaining ring—may contain liquid, powder, or compressed powder

back 137

Vial:Medication Identification

front 138

All drugs must be labeled by the manufacturer and the label must contain the following information
•Drug name (trade and generic)
•Manufacturer
•Strength
•Amount
•Expiration date
•Route of administration
•Lot number
•Handling/storage precautions and warnings
•Instructions for reconstitution (if applicable)
•Controlled substances classification (if applicable)

back 138

Drug labels by the manufacturer Must contain...

front 139

Parts of a needle

back 139

front 140

Circulator cleans the stopper at the top of the vial using an alcohol wipe and holds the vial at an angle while the surgical technologist inserts a hypodermic needle attached to the syringe through the stopper and withdraws the medication.

back 140

Medications from a vial may be transferred by one of four methods

front 141

Circulator inserts a sterile medication vial transfer device (a long straw-like device with a spiked end) into the vial stopper and pours the medication into a container on the back table.

back 141

Medications from a vial may be transferred by one of four methods

front 142

Circulator medication into a syringe using the hypodermic needle, and ejects the mediation into the container on the back table.

back 142

Medications from a vial may be transferred by one of four methods

front 143

•Circulator removes the metal retaining ring and rubber stopper and pours the medication into the container on the back table.

back 143

Medications from a vial may be transferred by one of four methods

front 144

Circulator removes the top of the ampule, draws the medication into a syringe using the hypodermic needle, and ejects the medication into the container on the back table.

back 144

Medications from an ampule may be transferred using one of two methods:

front 145

Circulator removes the top of the ampule and holds it at a slight angle while the surgical technologist withdraws the medication into a syringe via hypodermic needle

back 145

Medications from an ampule may be transferred using one of two methods

front 146

What methods are squeezed by the circulator onto a towel, into a small cup or directly onto a sterile dressing material on the back table.

back 146

Medications from a tube

front 147

Surgical-technologist-crafted labels using a sterile marking pen and a blank sterile label. If blank labels are not available, what may be used

back 147

a sterile skin closure tape (Steri-Strip™) is a possible alternative
LABEL MAKESHIFTS

front 148

What is ratio of solute to solvent

back 148

Concentration

front 149

What is the overall amount of medication delivered to the patient

back 149

Dose

front 150

What can also be expressed as a decimal by moving the decimal point two places to the left of the written number to indicate hundredths

back 150

%. Percentages
75% = 0.75 or 75/100

front 151

Examples of percentage calculations

back 151

•15 is what percentage of 30?
15/30 = 0.50 or 50%

•What is 20% of 80?
Change the 20% to a decimal and multiply by 80:
20% = 0.20 × 80 = 16

front 152

What temperature reference points are frequently referenced in the OR

back 152

1. Boiling point of water, 212°F or 100°C 2. Freezing point of water, 32°F or 0°C
3. Normal body temperature, 98.6°F or 37°C

front 153

The conversion formulas for converting between Fahrenheit and Celsius scales are

back 153

(°F − 32) 5/9 = °C

(°C × 9/5) + 32 = °F

front 154

What are the three classifications of drugs that are associated with surgical interventions of the female reproductive tract

back 154

Oxytocics, vasopressin, and immunoglobin

front 155

What drugs are used to induce labor and control uterine hemorrhage associated with pregnancy and childbirth.

back 155

Oxytocic drugs

front 156

What drug is used to induce or continue labor, contract the uterus following vaginal or cesarean birth, and as an adjunct in the treatment of incomplete or spontaneous abortion, planned abortion, and to control uterine bleeding following an abortion

back 156

Oxytocin (Pitocin, Syntocinon)

front 157

What is the second medication used in gynecologic surgery involving the cervix. It is injected around the cervix during a vaginal hysterectomy, cervical conization, or into a uterine fibroid during myomectomy to reduce intraoperative bleeding.

back 157

Vasopressin (Pitressin)

front 158

What immunoglobin, is administered to Rh-negative women who are pregnant to prevent sensitization of the maternal immune system when pregnant with an Rh-positive fetus

back 158

RhoGam
Maternal Rh antibodies can cross the placenta during subsequent pregnancies, where the antibodies destroy fetal circulating red blood cells.

front 159

What are the routine pharmacological supplies used in orthopedic surgery

back 159

Antibiotics, hemostatic agents, and steroids

front 160

What drugs are mixed with irrigation solutions or injected into the bags of solution used during irrigation and/or pulsed lavage of the surgical wound.

back 160

Polymixin, bacitracin, and cephalosporin antibiotics

front 161

What agents are used in orthopedic surgery include absorbable gelatin sponge (Gelfoam), microfibrillary collagen (Avitene), thrombin (Thrombinar), and bone wax

back 161

Hemostatic agents
“Chemical Methods of Hemostasis”

front 162

What drugs are used for their anti-inflammatory action. Dexamethasone (Decadron), a short-acting corticosteroid; dexamethasone long-acting (Decadron LA); or betamethasone (Celestone),

back 162

Steroids

front 163

What drug is a long-acting corticosteroid, may be administered to reduce inflammation in a joint area caused by trauma

back 163

Betamethasone (Celestone)

front 164

What intravascular irrigation is commonly used during cardiac and peripheral vascular procedures,

back 164

Heparinized saline
Dilute and concentrated heparin solutions may be required, and must be labeled accordingly

front 165

Additional medications used during vascular procedures include
contrast media for ........

back 165

arteriography (Xray)

front 166

Additional medications used during vascular procedures include:
opical papaverine HCl (Papaverine) for .......

back 166

dilating blood vessels

front 167

Additional medications used during vascular procedures include:
lidocaine HCl for .........

back 167

local anesthesia

front 168

Additional medications used during vascular procedures include:
oxidized cellulose (Oxicel, Surgicel) for ........

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hemostasis

front 169

Drugs and solutions used during neurosurgical procedures include:
antibiotics in warm saline for .........

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irrigation
neurosurgical procedures

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Drugs and solutions used during neurosurgical procedures include: heparinized saline solution for ..........

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intravascular irrigation
neurosurgical procedures

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Drugs and solutions used during neurosurgical procedures include:
contrast media for .........

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cerebral arteriography
neurosurgical procedures

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Drugs and solutions used during neurosurgical procedures include: topical papaverine HCl (Papaverine) for ............ during procedures involving cerebral vasculature

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dilating blood vessels
neurosurgical procedures

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Drugs and solutions used during neurosurgical procedures include:
polifeprosan 20 with carmustine implants (Gliadel Wafers) for ........

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topical placement onto the post-resection tumor bed for the treatment of glioblastoma multiforme

neurosurgical procedures

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Drugs and solutions used during Ophthalmic Surgery:
What agents cause the iris to contract, resulting in dilation of the pupil referred to as mydriasis

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Mydriatics and cyclopleoic
Ophthalmic procedures

front 175

Drugs and solutions used during Ophthalmic Surgery:
The commonly used mydriatic agent is called .....

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phenylephrine HCl (Neo-Syne.hrine).
Ophthalmic procedures

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Drugs and solutions used during Ophthalmic Surgery:
The commonly used cycloplegic agents include

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Tropicamide (Mydriacyl), cyclopentolate (Cyclogyl), and atropine sulfate (Atropisol)
Ophthalmic procedures

front 177

What agents act on the iris, resulting in iris relaxation and, therefore, pupil constriction.

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Miotic
Ophthalmic procedures

front 178

Drugs and solutions used during Ophthalmic Surgery:
Miotic agents include ........

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Pilocarpine HCl (Pilocar, Isopto Carpine) and carbachol (Miostat).
Ophthalmic procedures

front 179

What drugs also facilitate the drainage of aqueous humor through the trabecular meshwork of the canal of Schlemm, thus decreasing intraocular pressure (IOP), making them useful for the treatment of increased IOP due to glaucoma

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Miotic drugs
Ophthalmic procedures

front 180

What ophthalmic agents are used to expand the anterior chamber and prevent injury to the corneal endothelium and surrounding tissues during cataract extraction

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Viscoelastic/viscosurgical (can also be used to replace vitreous humor)
Ophthalmic procedures

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Drugs and solutions used during Ophthalmic Surgery:
What are commonly used viscoelastic agents.

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Chondroitin sulfate-sodium hyaluronate (Viscoat) and sodium hyaluronate (Healon, Amvisc)
Ophthalmic procedures

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Drugs and solutions used during Ophthalmic Surgery:
What are the most commonly used topical anesthetics in ophthalmic surgery

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Tetracaine (Pontocaine) and proparacaine (Ophthaine
Ophthalmic procedures

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In ophthalmic procedures which anesthesia may be necessary for some procedures to block both sensory and motor nerve function

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Retrobulbar
Ophthalmic procedures

front 184

Which anesthesia is accomplished by injecting the area around the optic nerve with a combination of lidocaine HCl and bupivacaine, both without epinephrine

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Retrobulbar anesthesia

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What irrigation fluid is used during ophthalmic surgery to keep the cornea from drying out

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Balanced salt solution

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What is a sterile mix of beeswax, the body recognizes as a foreign body, and can reject or react to

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Bone wax

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What is used in thoracic surgery when the sternum is split, in neurosurgical procedures when a craniotomy is performed, and for orthopedic and otorhinolaryngologic (ENT) procedures

back 187

Bone wax

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What sponge is placed over an area of bleeding, and fibrin is deposited initiating clot formation. It may also be soaked in epinephrine to enhance vasoconstriction

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Absorbable Gelatin Sponge

front 189

Absorbable Gelatin Sponge is absorbed by the body in how many days

back 189

30 days

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What collagen is soluble, and as hemostasis occurs, it is absorbed and eliminated from the body. It should be kept dry to avoid it becoming sticky

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Microfibrillar Collagen (Avitene)

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What products are available in the form of pads (Nu-Knit, Fibrillar, and SNoW) or fabric (Surgicel—Original). Blood clots rapidly form in the presence of these products. Absorbed and eliminated from body

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Oxidized Cellulose

front 192

What is often used to control cervical or nasal bleeding. It is applied either in stick form as a caustic pencil or in solutions of 0.01% to 10% silver nitrate.

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Silver Nitrate

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What is a potent vasoconstrictor and is often combined with local anesthetic agents or with Gelfoam to aid in local hemostasis. It is absorbed rapidly by the body but provides good localized hemostasis.

back 193

Epinephrine

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What is an enzyme that results from the activation of prothrombin, it is of bovine (cow) and never injected. It should be discarded if not used in several hours

back 194

Thrombin

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Estimated Blood Loss
Calculated by a wet/dry formula, sponges used, suction canisters etc

back 195

EBL

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All components of blood—not commonly used. Used to treat trauma-induced hemorrhage

back 196

Whole blood

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What is from 1 unit of whole blood after most of plasma is removed. Used to restore oxygen-carrying capacity

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Packed red blood cells (PRBCs)

front 198

What is the fluid component of blood containing clotting factors removed from 1 unit of whole blood Restores clotting factors; usually 1 unit of FFP is given for every 4 units of PRBCs

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Fresh-frozen plasma (FFP)

front 199

What are removed from 1 unit of whole blood. Used to enhance blood clotting ability when the count is low—less commonly used

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Platelets

front 200

Unused blood should be stored in a refrigerator at a temperature between

back 200

1° and 6°F (33.8−42.8°C)

front 201

What involves the use of the patient’s own blood that has been processed for reinfusion

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Autotransfusion

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What is blood collected in for use in auto-transfusion

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Autologous blood retrieval system (Cell Saver®)