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the study of medications and their actions including drug origins, properties and uses. (pg. 204)


study of the interaction of drug molecules with the target cells of living tissue.

Medication Actions

Synergistic Agents
Additive Agents


agonistic interaction occurs when a drug potentiates or enhances the effect of another substance.
Ex: synergists and additives

Synergistic Agents

Synergists act in combination to produce a stronger or more powerful effect than would be demonstrated if each agent was administed individually.

Additive Agents

Medication additives alter some aspect of the action of the original agent.
Example: adding epinephrine to lidocaine


an AGONIST is a medication that binds to a specific receptor site in the body, producing an alteration in biological function and resulting in a desired effect.
-an ANTAGONIST binds to the agonist's receptor site, preventing the agonist from binding there and causing it's desired effect.

(Basically, it is a drug that reverses the effects of another drug)
pg 205

Therapeutic Action:

listing of medical conditions that the medication is know to treat
pg 205

Therapeutic Action:

list of circumstances or medical conditions under which the medication should not be used
Onset: effects of meds begin showing
Peak: effects of meds at peak
pg 205

Medication effect:

the concentration or dose of a medication used to produce the desired result without producing a harmful effect

Medication Effect:
Side Effect

an expected, undesirable, but tolerable effect of a medication.
(ex: dry mouth, constipation, diarrhea, dizziness or drowsiness)

Adverse Effect:

an undesirable and potential harmful effect of a medication that can lead to organ damage or failure.

Toxic Effect

undesirable, unacceptable effects of a medication.
can cause CANCER

Drug Effect:

reduction in the effect of a medication given at the same dose over a period of time


a physical or psychological dependency on the effects of medication


term to describe entire process of a drug within the body.
pg 206


drug must be absorbed to produce an effect.


involves the transport of the medication within the body once it enters the circulatory system


Biotransformation = metabolism.
-mainly broken down in liver


the effect of medication in the body continues until it is biotransformed or excreted.
Kidneys partially responsible for the filtration of medications


Route of Administration
(meaning per os or by mouth) through the GI tract

Route of Administration:

placed into the rectum

Route of Administration:

Between the layers of the skin

SC or SQ

Under the skin into the adipose tissue layer


(within the muscle)


(into a vein)

Route of Administration:

within a joint

Route of Administration:

Into the subarachnoid space

Route of Administration:

Into the heart


applied to the skin or mucous membrain


medication is placed between the cheek and the teeth until it is dissolved or absorbed


Medication is placed in a hollow or cavity

(such as the conjunctival fold or bladder)


medication is directly administered via the

Pg 209

the concentration of a medication is the ratio of solute to solvent. The two components of a solution

4 stages of General Anesthesia
(pg 227)

Stage 1: amnesia stage
Stage 2: delirium stage (excitement)
Stage 3: surgical anesthesia stage
Stage 4: overdosage stage

4 Phases of General anesthesia

Induction phase
Maintenance phase
Emergence phase (hearing is the last thing to go)
Recovery phase

Drug Handling Techniques: pg 212

6 basic rights for correct drug handling

1. The right patient
2. The right drug
3. The right dose
4. The right route of administration
5. The right time and frequency
6. The right documentation, including labeling

Sellick's maneuver

cricoid pressure

Cricoid Pressure
(pg 228)

-performed to reduce the risk of aspiration.
-applied prior to induction of anesthesia and continue until the endotracheal tube is placed.
-employed in the OR in situations where the patient requires emergency surgery shortly after eating. or the NPO status is not verified, or GI bleeding

Laryngospasm and Bronchospasm
(pg 228)

-reactions demonstrated by the lightly anesthetized patient.
-a slight trigger of the "gag" reflex results in a spasm or rigidity of the upper respiratory tract....resulting in an inability of the air and waste gases to move in and out of the lungs.

-SUCCINYLOCHOLINE = drug, neuromuscular blocker - relaxes spasm
(can cause Malignant Hyperthermia)

Malignant Hyperthermia
(pg 229)

-not "hypo"
(drug, SUCCINYLCHOLINE can cause this and
Halogenated inhalation agents such as...
(desflurane, isoflurane, sevoflurane)


The skeletal muscles are stimulated to contract, but due to the inability of calcium to release, the muscles cannot relax, resulting in rigidity, heat generation, and a buildup of lactic acid and carbon dioxide.

-genetically transmitted disease seen more in males

First sign:
unexplained tachycardia (increase in heart rate), followed by tachypnea and an increased level of carbon dioxide.

Late sign: rise of temperature, as high as 107 degrees

-If it occurs, stop and give 100% oxygen
-MH cart on standby


neuro muscular blocker
can cause Malignant Hyerthermia

MH cart
(Malignant hyperthermia)

(designated for Malignant Hyperthermia, with supplies readily available)

-Dantrolene is the only phamacological agent for the treatment of MH, mixed with sterile water, given IV

-sodium bicarbonate,
dextrose and insulin,
furosemide or mannitol

- chilled IV fluids of saline dextrose (to regulate temp)
-chilled saline lavage - for body cavities

Drugs used during MH crisis

sodium bicarbonate:
to assist in metabolic and respiratory acidosis regulation

dextrose and insulin:
to provide available glucose to the cells to maintain cellular metabolism

furosemide or mannitol:
to promote renal clearance of waste products

to prevent intravascular clot formation


Only pharmacological agent for the treatment of MH
-mixed with sterile water
ANTAGONIST for MH (reverses)

Anesthetic agents:
3 categories

inhaltion agents
intravenous agents
local/regional agents

Inhalation agents
(pg 230)

Anesthetic agents that are inhaled and pass into the bloodstream via pulmonary function.

pulmonary function

pertaining to the lungs


Inhalation agent:
-not an anesthetic agent
-essential for survival of the patient...promotes respiration and cellular function

Nitrous oxide

-clear, colorless, fruity odor
-only true gas still in use
-interacts with the cellular membrane of the CNS to produce ANALGESIA with some amnesia.
-eliminated by exhalation
-used in conjunction of other anesthetic agents (not strong enough alone)
- CONTRAINDICATING its use during some surgical interventions such as tympanoplasty
-may contribute to postoperative nausea and vomiting.


Medication that helps enhance effect of other drug


reverses effects of other drug

Drug sources
(pg 205)

Laboratory synthesis


Drug source



Drug source

Primarily hormones are derived form animal sources including human sources.
-Cows - bovine
-pigs - porcine



Drug source

From the earth

Laboratory synthesis

Drug source

manufactured in a laboratory.
-Two methods:
synthetic drugs
semisynthetic drugs

Synthetic drugs

manufactured totally from laboratory chemicals.
-Meperidine sulfate (Demerol)

Semisynthetic drugs

begin with a natural substance which is then chemically altered.

-aminoglycoside group of antibiotics

recombinant DNA technology

"recombinant DNA technology"

-DNA is artificially constructed by introducing foreign DNA into the DNA of a specific organism - daughter cell created
-cell reproduction

Hepatitis B vaccine

3 Legal Drug Classifications

Controlled Substances
Prescribed Medications
Over-the-counter medications

Controlled substances

drugs with a high potential to cause psychologigical and or physical dependence and abuse.
(labeled classes 1 - 4)

Prescribed Medications

medications that are prescribed but if used inappropriately, could cause significant harm to the patient

Over the Counter Medications

pharmacologic agents that are prepared in a dosage that are generally safe to administer without the direction of a physician


(ends in "ane" = can trigger MH)
drugs that are in liquid form - potent vapors are inhaled to cause effects
-sevolfurane, desflurane, isoflurane
less commonly used: enflurane and halothane


Rapid and smooth onset and recovery
ideal agent for both adult and pediatric inhalation induction

Disadvantages: causes bradycardia, hypotension, cardiac dysrhythmias and reduces cardia output
-may also cause nausea and vomiting in the postoperative period.
-renal complications


-requires the use of a heated vaporizer

It has a pungent aroma, CONTRAINDICATING its use during inhalation induction.
-Rapid onset and recovery
-not biotransformed in the liver, it is safe to use for patients with hepatic insufficiency
-Less expensive than sevoflurane
-causes nausea and vomiting like sevoflurane



pungent, musty smelling

-rapid induction and recovery
-respiratory depressant
-potentiates neuromuscular blockade
-may cause hypotension
-increases intracranial pressure (ICP), which is reversible with hyperventalation


sedative, hypnotic

Intravenous Agents I.V.
(pg 230)

-induction agents
-dissociative agents
-neuromuscular blocking agents
antimuscarinic (anticholinergic) agents
-adjunctive agents

Induction agents (IV)

permit a rapid and pleasant transition from consciousness (Stage 1) to unconsciousness (Stage 3) by quickly passing through the delirium stage (Stage 2)

-Side effects: Hypotension and respiratory depression
- may also be used during maintenance of general anesthesia
Drugs: Propofol, Etomidate, Thiopental sodium, Methohexital sodium



"Milk of amnesia"
-sedative-hypnotic agent
-discarded within 6 hrs of opening
-irritating to the vein and may cause patient discomfort at the IV site
(Lidocaine given IV just prior to propofol inj. may ease that discomfort)

-Rapid induction and emergence without the prolonged "hangover" effect

-CONTRAINDICATED: for patients with unstable hemodynamics or head trauma.



nonbarbiturate hypnotic agent used for anesthesia induction
-similar to propofol, but does not produce analgesia

INDICATED: choice for anesthesia induction of the hemodynamically unstable patient indications

COMPLICATION - postoperative nausea and vomiting (POVN) as well as adreanal suppression are seem more frequently in patients given etomidate

Thiopental sodium

(Pentothal Sodium)

-short- acting potent barbiturate
-does NOT provide anesthesia or muscle relaxation
-has hypnotic, amnesic, and sedative effects.

-Leaves patient with a residual hangover effect lasting through and prolonging the patient's emergence and recovery phases.

-marked respiratory and circulatory depression immediately following injection, non flammability, inability to cause irritation to the respiratory tree, and lack of salivary stimulation
-Helps reduce Laryngospasm and Bronchospasm due to decreasing saliva

-minor patient stimulation during the lighter stages of anesthesia administration, which may cause laryngospasm, and the alkaline nature of the drug, which may be locally irritating to the vein.

Halogenated anesthetic agents

considered triggering agents for malignant hypothermia

(pg 231)

selectively interrupt the associative pathways of the brain. Patients may appear wide awake, yet they are unaware of their surroundings.
-Produce amnesia and profound analgesia.

-Ketamine hydrochloride (Ketalar)

Ketamine hydrochloride

-most commonly used dissociative agent.
-administered IM or IV

-production of vivid imagery and morbid hallucinations during administration and recovery.
-causes hypertention
-limited use to children 2 - 10 years old.

produces amnesia and analgesia while patient is wide awake

Contraindication: triggers laryngospasm due to SALIVA INCREASE


CLASS II controlled substances
-not handled by CSTs
-narcotics classified as analgesics = sedation

-Morphine sulfate, meperidine, fentanyl citrate, sufentanil citrate, alfentinal hydrochloride, remifentanil hydrochloride,

Morphine sulfate

used for the control of severe pain.
-given IM = preoperative sedative/analgesic
-postoperative = analgesic
iv - anesthetic agent
-intrathecally - spinal pain control

side effects. bradycardia (slow heart), hypotension, vasodialation, nausea, vomiting, confusion, respiratory depression


similar to morphine
-used to treat moderate to severe pain

DISADVANTAGES: side effects.
increased ICP, tachycardia and vasodilaton (causes Malignant Hyperthermia)

Fentanyl citrate



the first of the synthetic narcotic analgesics to be used for anesthesia administration.

-use with patients with myasthenia gravis is contraindicated

Sufentanil citrate

similar to fentanyl, but five times more potent
-produces analgesia
-respiratory depressant
-has a rapid onset of action when given IV
-It has a short duration of activity and is rapidly eliminated

Alfentanil hydrochloride

similar in action and usage to fentanyl
-short acting analgesic

Disadvantage: induced respiratory depression may outlast the analgesic effect produced

Remifentanil hydrocholoride

short duration. 5 -10 min.
synthetic opiod metabolized in blood and muscle tissue.
DISADVANTAGE: may cause respiratory depression, brady cardia, hypotension, and muscle rigidity.
ADVANTAGE: short duration, allows more accurate dose titration (method of estimating amount of solution)

Muscle rigidity


Narcotic Antagonists
(pg. 232, important)

The opioid effect can be antagonized or reversed by the administration of
naloxone hydrochloride (Narcan)

(pg 232)

sedative tranquilizers
2 ways:
-to reduce the anxiety and apprehension of the preoperative patient
-as an adjunct to general anesthesia to reduce the amount and concentration of anther more potent agents

(Diazepam, Midazolam, Droperidol)


CLASS 4 controlled substance
-primary anesthetic use is to reduce ANXIETY and provide some skeletal muscle relaxation.
-provides retrograde amnesia of short duration.
-Given IV
-5 -15 min = onset of action



Class 4

-rapid onset and short acting
-ideal for patients undergoing outpatient procedures
-short duration memory impairment
-twice as potent as diazepam
-IV dosage is diluted with injectable dextrose/water/saline


-produces marked sedation with a long duration of action.
-mild amnesia

Droperidol premixed with fentanyl citrate

trade name: INNOVAR
-provides a combination of sedation and analgesia

Amino Amide Group
(pg 236)

drugs in this group are metabolized in the liver and excreted by the kidneys and include:
-lidocaine, mepivicane, bupivacain, etidocain

Regional Anesthesia

(refer to notes)


high blood pressure


LOW blood pressure

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