Principles of Surgical Pharmacology

1. Principles of Surgical Pharmacology ST210 Concorde Career College

2. Principles of Surgical Pharmacology History of Pharmacology

3. Objectives: • Define the term pharmacology • Provide a timeline of the events leading up to modern pharmacologic practice • Perform basic mathematical calculations to allow conversion between the various measurement systems and correct drug dosages

4. Definition Pharmacology = the study or science of drugs Root derived from Greek terms farmakon (drug) and logy (science or study of)

5. Definition • Drug • Substance used as medicine for the diagnosis, treatment, cure, mitigation, or prevention of disease or a condition

6. Definition Pharmacology concepts include: • Composition (properties) • Uses (medical mechanism of action) • Effects (characteristics)

7. Related Definitions Pharmacologist = one who has knowledge of drugs and the art of drug preparation (usually works in a research setting) Pharmacist = health professional educated in the art of preparing and dispensing drugs (usually works in a hospital or retail pharmacy)

8. History of Pharmacology Prehistoric – Accidental discoveries Evidence of prehistoric healing arts is obtained from: Wall Paintings Carvings Burial sites

9. History of Pharmacology Ancient – Known drugs and healing techniques were utilized along with magic, religion, and rituals Use of drugs systematically recorded as evidenced by Egyptian Papyri, Cuneiform Medical Tablets, and Chinese inscriptions

10. History of Pharmacology Classical – First pharmacies • Hippocrates (Father of Medicine) – Hippocratic Oath developed during this period • Galen (incorrect anatomical descriptions unchallenged for 1500 years) – Introduced minerals to pharmacology and began to soak, boil, and mix the preparations creating syrups, tinctures, etc.

11. History of Pharmacology Middle Ages – New (sweet) formulations • Greek and Roman teachings began to incorporate techniques from Asia • Islamic physician IbnSina (aka – Avicenna) made impressive additions to the works of Galen and Dioscorides (Turkish physician – educated in Greece – wrote the first text on botany and pharmacology that was free from superstition called the De MateriaMedica “on medical matters”)

12. History of Pharmacology Renaissance – The age of enlightenment • Advances in metallurgy and chemistry

13. History of Pharmacology New World – Spanish exploration led to the introduction of Central and South American remedies to the Europeans. Some of the medicines are still in use today (e.g., ipecac, nicotine, hallucinogenics, cocaine, and quinine – used to treat malaria).

14. History of Pharmacology Modern – Pharmacology as an individual science/legislation developed (standardization)

15. Principles of Surgical Pharmacology Mathematical Calculations and Conversions

16. Objectives: • Perform basic mathematical calculations to allow conversion between the various measurement systems and correct drug dosages

17. Measurements/Conversions • Refer to the Metric Conversion Charts, Appendix C on Pages 1206-1207 of Surgical Technology for the Surgical Technologist: A Positive Care Approach, 4th Edition

18. Measurements/Conversions • Important calculations • Concentration: ratio of solute to solvent • Dose: overall amount of medication delivered to the patient • Application: medication’s use in the surgical setting

19. Calculating Medication Dosages • Concentration • Convert solute to solvent • A:B = C:D • Cumulative dose • Calculated by taking the amount of solution delivered and multiplying it by the amount of solute from the ratio above

20. Percentages • Characteristics of a percentage • Represents a fraction in which the denominator is always 100 • Expressed as a whole number followed by the percent symbol (%) • Can also be expressed as a decimal by moving the decimal point two places to the left of the written number to indicate hundredths

21. Conversion of Temperature • Scales used to measure temperature • Fahrenheit and Celsius • Monitoring body temperature is important • If not in normal range, surgical procedure may be delayed or canceled • Hypothermia is a concern intraoperatively • Certain anesthetic agents affect the thermoregulatory centers in the brain, leading to the body’s inability to adapt to temperature changes

22. Units of Measure • Metric system • Based on powers or multiples of 10 • Value of numbers established by the use and placement of a decimal point to indicate whole numbers versus fractions • Metric, household, and apothecary systems of measurement • Household: refer to text for abbreviations • Apothecary system: based on weight of a grain of wheat

23. Weight Conversions Practice 1.5g = 1500 mg 52 lb = 23.64 kg 46 kg = 101.2 lb 78 kg = 171.6 lb 500 mg = 0.5 g 4000 g = 4 kg

24. Weight Conversions Practice 5 g = 5000 mg 240 lb = 109.09 kg 300 mg = 0.3 g 2 g = 2000 mg 220 kg = 484 lb 175 lb = 79.55 kg

25. Length Conversions Practice 1 m = 39.38 inches 1 inch = 2.54 cm 4 cm = 1.6 inches 10 cm = 4 inches 12 inches = 30 cm

26. Length Conversions Practice 30 cm = 12 inches 6 inches = 15.24 cm 1 yard = 36 inches

27. Volume Conversions Practice 1 ml = 1 cc 4 cc = 4 ml 2 oz = 60 cc 5 liters = 5000 cc 1.5 liters = 1500 ml

28. Volume Conversions Practice 0.5 oz = 15 ml 500 cc = 0.5 L 0.75 L = 750 cc 1 gallon = 4000 cc 12 ml = 0.41 oz 15 gtt or minims = 0.6 cc

29. Temperature Conversions (textbook method = fractions – eeeewwww!!!!) Convert Fahrenheit to Celsius °C = (°F – 32) 5/9 Which means: • Subtract 32 from °F • Multiply by 5 • Divide by 9

30. Temperature Conversions (textbook method = fractions - eeeewwww!!!!) Convert Celsius to Fahrenheit °F = (°C x 9/5) + 32 Which means: • Multiply °C by 9 • Divide by 5 • Add 32

31. Temperature Conversions (another method = no fractions – WOW!) • Convert Fahrenheit to Celsius (°F - 32) x 0.56 = °C • Convert Celsius to Fahrenheit (°C x 1.8) + 32 = °F

32. Temperature Conversions Practice 36° C = 96.8° F 32° F = 0° C 98.6° F = 37.3° C 100° C = 212° F 18° C = 64.4° F

33. Temperature Conversions Practice 101º F = 38.64º C 104º F = 40.42º C 212º F = 100º C 37.7º C = 99.86º F 91.4º F = 33.26º C

34. Basic Conversions • 1 g = 1000 mg • 1 kg = 2.2 lb • 1 cc = 14-15 minims • 1 L = 1000 cc • 212º F = 100º C • Boiling Point of Water

35. Basic Conversions • 1 minim = 1 gtt • 1 ounce = 30 cc • 98.6º F = 37º C • 100 ml = 100 cc • 1 meter = 100 cm

36. Abbreviations Related to Medication Administration • Medication errors have been attributed to the use of abbreviations • The Joint Commission—Official “Do Not Use” List • Refer to Table 9-11

37. Principles of Surgical Pharmacology Drug Classifications, Types, and Administration

38. Objectives • Discuss drug classifications and provide examples • Identify the five main drug sources and provide examples of drugs from each source • List and describe drug forms

39. Objectives • Differentiate between the three types of drug nomenclature • List and describe drug administration routes

40. Medication Information • Basic information • Names • Classifications • Actions • Indications • Dosage

41. Legal Drug Classifications • Controlled substances • Drugs with a high potential to cause psychological and/or physical dependence and abuse • Prescribed medications • Medications that, if used inappropriately, could cause significant harm to the patient

42. Controlled Substances • Controlled Substances (special prescription) • Schedule or Class I • Schedule or Class II • Schedule or Class III • Schedule or Class IV • Schedule or Class V

43. Legal Drug Classifications (cont’d.) • Over-the-counter (OTC) medications • Prepared in a dosage that are safe to administer without the direction of a physician • Alternative medications • There are limited studies to determine the safety and effectiveness of these therapies, resulting in a limited understanding

44. Drug Classifications • Chemical type • Body system affected • Physiological action • Therapeutic action

45. Classifications • Analgesic Relieves pain • Anesthetic Loss of sensation • Antibiotic Prevent/treat infection • Anticholinergic Block parasymp. impulses • Anticoagulant Prevents blood clotting

46. Classifications • Antiemetic prevents N&V • Antiinflammatory decrease swelling • Antipyretic decrease fever • Controlled substance narcotic • Contrast media X-ray delineation

47. Classifications • Cycloplegic Paralyze ciliary • Diuretic Increase urine • Dye Color tissue • Fibrinolytic Dissolve clot • Hemostatic Clot formation

48. Classifications • Hormone Endocrine secretion • Miotic Constrict pupil • Mydriatic Dilate pupil • Sedative Reduce anxiety • Vasoconstrictor Increase BP

49. Medications in the Operating Room • Common pharmacologic agents used in the OR setting • Refer to Table 9-13 • Medications used by the anesthesia care provider as part of the anesthesia delivery • Refer to Table 9-20

50. Medications for Use with Specific Surgical Specialties • Include: • Obstetric and gynecologic surgery: oxytocics, vasopressin, and immunoglobin • Orthopedic surgery: antibiotics, hemostatic agents, and steroids • Cardiovascular surgery: heparinized saline solution