Podcast
Questions and Answers
What is the primary reason for maintaining the potency and effectiveness of all drugs in perioperative care?
What is the primary reason for maintaining the potency and effectiveness of all drugs in perioperative care?
Which of the following drugs requires refrigeration to preserve its efficacy and therapeutic benefits?
Which of the following drugs requires refrigeration to preserve its efficacy and therapeutic benefits?
Why is it important to have an efficient organisation of drugs, especially those with similar labelling or packaging?
Why is it important to have an efficient organisation of drugs, especially those with similar labelling or packaging?
What is the primary purpose of the Controlled Drugs (Supervision of Management) Regulations (2013)?
What is the primary purpose of the Controlled Drugs (Supervision of Management) Regulations (2013)?
Signup and view all the answers
Who is responsible for adhering to the 6 R's framework prior to administering medication to patients?
Who is responsible for adhering to the 6 R's framework prior to administering medication to patients?
Signup and view all the answers
What is the minimum number of individuals required to be present during the checking process of controlled drug inventory?
What is the minimum number of individuals required to be present during the checking process of controlled drug inventory?
Signup and view all the answers
What is the purpose of recording the disposal of controlled drugs in the controlled drugs book?
What is the purpose of recording the disposal of controlled drugs in the controlled drugs book?
Signup and view all the answers
What is the primary purpose of the 6 R's framework?
What is the primary purpose of the 6 R's framework?
Signup and view all the answers
What is the role of the HCPC in relation to controlled drug safety?
What is the role of the HCPC in relation to controlled drug safety?
Signup and view all the answers
What is the consequence of administering the wrong drug to patients?
What is the consequence of administering the wrong drug to patients?
Signup and view all the answers
Why is it crucial to confirm the patient's identity before administering drugs?
Why is it crucial to confirm the patient's identity before administering drugs?
Signup and view all the answers
What is the purpose of labelling syringes in the administration of drugs?
What is the purpose of labelling syringes in the administration of drugs?
Signup and view all the answers
What is the primary site of metabolism for propofol?
What is the primary site of metabolism for propofol?
Signup and view all the answers
What is the significance of using gloves when handling medications?
What is the significance of using gloves when handling medications?
Signup and view all the answers
What is the primary effect of propofol on the cardiovascular system?
What is the primary effect of propofol on the cardiovascular system?
Signup and view all the answers
How is propofol primarily administered?
How is propofol primarily administered?
Signup and view all the answers
What percentage of propofol is bound in the plasma?
What percentage of propofol is bound in the plasma?
Signup and view all the answers
What is the primary route of excretion for propofol?
What is the primary route of excretion for propofol?
Signup and view all the answers
What is the significance of confirming allergies with the patient before administering drugs?
What is the significance of confirming allergies with the patient before administering drugs?
Signup and view all the answers
What is pharmacokinetics defined as?
What is pharmacokinetics defined as?
Signup and view all the answers
What is the primary mechanism by which propofol inhibits the respiratory system?
What is the primary mechanism by which propofol inhibits the respiratory system?
Signup and view all the answers
What is the recommended caution when administering propofol to patients with hypovolemia?
What is the recommended caution when administering propofol to patients with hypovolemia?
Signup and view all the answers
What is the bioavailability of ondansetron when absorbed by the gastrointestinal tract?
What is the bioavailability of ondansetron when absorbed by the gastrointestinal tract?
Signup and view all the answers
What is the maximum dose of ondansetron recommended for IV administration?
What is the maximum dose of ondansetron recommended for IV administration?
Signup and view all the answers
What is the primary mechanism by which alfentanil is metabolized?
What is the primary mechanism by which alfentanil is metabolized?
Signup and view all the answers
What is the typical dose of alfentanil for general anaesthesia?
What is the typical dose of alfentanil for general anaesthesia?
Signup and view all the answers
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
Signup and view all the answers
What is the primary storage requirement for alfentanil?
What is the primary storage requirement for alfentanil?
Signup and view all the answers
What is the primary reason for the rapid excretion of alfentanil in the urine?
What is the primary reason for the rapid excretion of alfentanil in the urine?
Signup and view all the answers
What is the primary concern when using ondansetron in combination with other serotonergic medications?
What is the primary concern when using ondansetron in combination with other serotonergic medications?
Signup and view all the answers
What percentage of atracurium metabolism is non-enzymatic?
What percentage of atracurium metabolism is non-enzymatic?
Signup and view all the answers
What is the recommended initial dose of atracurium for intubation in adults?
What is the recommended initial dose of atracurium for intubation in adults?
Signup and view all the answers
What is the main reason for caution when using atracurium in patients with hypothermia?
What is the main reason for caution when using atracurium in patients with hypothermia?
Signup and view all the answers
What is the primary route of excretion for sevoflurane?
What is the primary route of excretion for sevoflurane?
Signup and view all the answers
What is the maximum concentration of sevoflurane used during the induction phase?
What is the maximum concentration of sevoflurane used during the induction phase?
Signup and view all the answers
What is a potential complication of using sevoflurane in patients with head injuries?
What is a potential complication of using sevoflurane in patients with head injuries?
Signup and view all the answers
What is the primary use of sodium chloride 0.9% in this scenario?
What is the primary use of sodium chloride 0.9% in this scenario?
Signup and view all the answers
What is the minimum oxygen saturation level to be maintained?
What is the minimum oxygen saturation level to be maintained?
Signup and view all the answers
What is the risk associated with storing oxygen cylinders near electrical equipment?
What is the risk associated with storing oxygen cylinders near electrical equipment?
Signup and view all the answers
What is the primary method of administering alfentanil?
What is the primary method of administering alfentanil?
Signup and view all the answers
What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?
What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?
Signup and view all the answers
What is the primary reason for caution when using atracurium in patients with cardiovascular disease?
What is the primary reason for caution when using atracurium in patients with cardiovascular disease?
Signup and view all the answers
What is the maximum concentration of sevoflurane used during the induction phase?
What is the maximum concentration of sevoflurane used during the induction phase?
Signup and view all the answers
What is the primary route of excretion for sevoflurane?
What is the primary route of excretion for sevoflurane?
Signup and view all the answers
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
Signup and view all the answers
What is the minimum oxygen saturation level to be maintained?
What is the minimum oxygen saturation level to be maintained?
Signup and view all the answers
What is the risk associated with storing oxygen cylinders near electrical equipment?
What is the risk associated with storing oxygen cylinders near electrical equipment?
Signup and view all the answers
What is the primary concern when using sevoflurane in patients with head injuries?
What is the primary concern when using sevoflurane in patients with head injuries?
Signup and view all the answers
What is the recommended initial dose of atracurium for intubation in adults?
What is the recommended initial dose of atracurium for intubation in adults?
Signup and view all the answers
What is the primary mechanism of action of atracurium?
What is the primary mechanism of action of atracurium?
Signup and view all the answers
What is the primary mechanism by which alfentanil is metabolized in the body?
What is the primary mechanism by which alfentanil is metabolized in the body?
Signup and view all the answers
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
Signup and view all the answers
What is the typical dose of atracurium for endotracheal intubation in adults?
What is the typical dose of atracurium for endotracheal intubation in adults?
Signup and view all the answers
What is the primary route of excretion for alfentanil?
What is the primary route of excretion for alfentanil?
Signup and view all the answers
What is the primary storage requirement for alfentanil?
What is the primary storage requirement for alfentanil?
Signup and view all the answers
What is the protein binding extent of alfentanil in the body?
What is the protein binding extent of alfentanil in the body?
Signup and view all the answers
What is the typical onset of action for atracurium?
What is the typical onset of action for atracurium?
Signup and view all the answers
What is the primary reason for the rapid excretion of alfentanil in the urine?
What is the primary reason for the rapid excretion of alfentanil in the urine?
Signup and view all the answers
What is the primary concern when using alfentanil in patients with hypothyroidism?
What is the primary concern when using alfentanil in patients with hypothyroidism?
Signup and view all the answers
What is the typical dose of alfentanil for general anaesthesia?
What is the typical dose of alfentanil for general anaesthesia?
Signup and view all the answers
What is the primary reason for storing alfentanil in a locked cupboard?
What is the primary reason for storing alfentanil in a locked cupboard?
Signup and view all the answers
What percentage of alfentanil is bound to proteins in the body?
What percentage of alfentanil is bound to proteins in the body?
Signup and view all the answers
What is the primary route of excretion for alfentanil?
What is the primary route of excretion for alfentanil?
Signup and view all the answers
What is the typical dose of alfentanil for general anaesthesia?
What is the typical dose of alfentanil for general anaesthesia?
Signup and view all the answers
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
Signup and view all the answers
What is the primary mechanism of action of atracurium?
What is the primary mechanism of action of atracurium?
Signup and view all the answers
What is the onset of action of atracurium?
What is the onset of action of atracurium?
Signup and view all the answers
What is the primary reason for caution when using atracurium in patients with hypothermia?
What is the primary reason for caution when using atracurium in patients with hypothermia?
Signup and view all the answers
What percentage of atracurium metabolism is non-enzymatic?
What percentage of atracurium metabolism is non-enzymatic?
Signup and view all the answers
What is the recommended initial dose of atracurium for intubation in adults?
What is the recommended initial dose of atracurium for intubation in adults?
Signup and view all the answers
What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?
What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?
Signup and view all the answers
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
Signup and view all the answers
What is the maximum concentration of sevoflurane used during the induction phase?
What is the maximum concentration of sevoflurane used during the induction phase?
Signup and view all the answers
What is the primary route of excretion for sevoflurane?
What is the primary route of excretion for sevoflurane?
Signup and view all the answers
What is the primary concern when using sevoflurane in patients with head injuries?
What is the primary concern when using sevoflurane in patients with head injuries?
Signup and view all the answers
What is the recommended initial dose of atracurium for intubation in adults?
What is the recommended initial dose of atracurium for intubation in adults?
Signup and view all the answers
What is the primary mechanism of action of atracurium?
What is the primary mechanism of action of atracurium?
Signup and view all the answers
What is the main reason for caution when using atracurium in patients with hypothermia?
What is the main reason for caution when using atracurium in patients with hypothermia?
Signup and view all the answers
What is the primary purpose of administering oxygen in this scenario?
What is the primary purpose of administering oxygen in this scenario?
Signup and view all the answers
What is the risk associated with storing oxygen cylinders near electrical equipment?
What is the risk associated with storing oxygen cylinders near electrical equipment?
Signup and view all the answers
What percentage of atracurium metabolism is non-enzymatic?
What percentage of atracurium metabolism is non-enzymatic?
Signup and view all the answers
What is the primary concern when using sevoflurane in patients with head injuries?
What is the primary concern when using sevoflurane in patients with head injuries?
Signup and view all the answers
What is the primary mechanism of action of alfentanil?
What is the primary mechanism of action of alfentanil?
Signup and view all the answers
Why is it important to be cautious when administering atracurium to patients with hypothermia?
Why is it important to be cautious when administering atracurium to patients with hypothermia?
Signup and view all the answers
What is the primary route of excretion for sevoflurane?
What is the primary route of excretion for sevoflurane?
Signup and view all the answers
What is the primary route of excretion for alfentanil?
What is the primary route of excretion for alfentanil?
Signup and view all the answers
What is the recommended initial dose of atracurium for intubation in adults?
What is the recommended initial dose of atracurium for intubation in adults?
Signup and view all the answers
What is the typical dose of alfentanil for general anaesthesia?
What is the typical dose of alfentanil for general anaesthesia?
Signup and view all the answers
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?
Signup and view all the answers
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
What is the primary purpose of administering sodium chloride 0.9% in this scenario?
Signup and view all the answers
What is the primary storage requirement for alfentanil?
What is the primary storage requirement for alfentanil?
Signup and view all the answers
What is the minimum oxygen saturation level to be maintained?
What is the minimum oxygen saturation level to be maintained?
Signup and view all the answers
What is the primary mechanism of action of atracurium?
What is the primary mechanism of action of atracurium?
Signup and view all the answers
What is the risk associated with storing oxygen cylinders near electrical equipment?
What is the risk associated with storing oxygen cylinders near electrical equipment?
Signup and view all the answers
What is the primary route of administration for atracurium?
What is the primary route of administration for atracurium?
Signup and view all the answers
What is the primary method of administering atracurium?
What is the primary method of administering atracurium?
Signup and view all the answers
What is the primary concern when using atracurium in patients with hypothermia?
What is the primary concern when using atracurium in patients with hypothermia?
Signup and view all the answers
What is the primary mechanism of action of atracurium?
What is the primary mechanism of action of atracurium?
Signup and view all the answers
What is the primary reason for the rapid excretion of alfentanil in the urine?
What is the primary reason for the rapid excretion of alfentanil in the urine?
Signup and view all the answers
What percentage of alfentanil binds to proteins in the body?
What percentage of alfentanil binds to proteins in the body?
Signup and view all the answers
Study Notes
Perioperative Care and Drug Administration
- Ensuring correct storage of drugs is crucial in perioperative care to maintain potency and effectiveness.
- Organising drugs in their appropriate locations is essential to prevent administering the wrong drug.
- Controlled drugs, such as alfentanil, must be kept locked in a cupboard and accounted for regularly.
Controlled Drug Safety
- Controlled drug safety is regulated by the Controlled Drugs (Supervision of Management) Regulations (2013).
- The disposal of controlled drugs should be recorded in the controlled drugs book and confirmed by a second witness.
- NICE guidelines (2016e) emphasize the need for a thorough check of controlled drug inventory.
6 R's Framework
- The 6 R's framework ensures the safe administration of drugs: Right patient, Right drug, Right route, Right dose, Right time, and Right documentation.
- Failure to perform these checks may result in harm to the patient and legal consequences for staff.
Patient Safety Checks
- Before administering medication, confirm the patient's identity, allergies, and prescription.
- Check the drug's name, stock strength, and dosage against the prescription.
- Handle medications properly to prevent administering incorrect drugs.
Pharmacokinetics and Pharmacodynamics
Propofol
- Pharmacokinetics: Propofol is absorbed by the body through IV administration, bound to albumin and erythrocytes, and metabolized by the liver.
- Pharmacodynamics: Propofol is an intravenous anaesthetic that causes a decrease in blood pressure and cardiac output, and impairs baroreceptor response.
Ondansetron
- Pharmacokinetics: Ondansetron is absorbed by the gastrointestinal tract, distributed into tissues, and metabolized by the liver.
- Pharmacodynamics: Ondansetron is an anti-emetic that prevents nausea and vomiting, with a dose-dependent effect on the prevention of PONV.
Alfentanil
- Pharmacokinetics: Alfentanil is absorbed by the body, bound to proteins, and metabolized by the liver.
- Pharmacodynamics: Alfentanil is a short-acting opioid that causes respiratory depression, and must be used with caution in patients with COPD.
Atracurium
- Pharmacokinetics: Atracurium is metabolized by non-enzymatic degradation and enzymatic metabolism, with less than 5% excreted in the urine.
- Pharmacodynamics: Atracurium is a non-depolarising neuromuscular blocking agent that causes muscle paralysis, with a recommended initial dose for intubation in adults.
Sevoflurane
- Pharmacokinetics: Sevoflurane is absorbed by the lungs, distributed by the lungs, and metabolized into inorganic fluoride and HFIP.
- Pharmacodynamics: Sevoflurane is an inhalation agent that causes malignant hyperthermia, increases intracranial pressure, and has common side effects.
Sodium Chloride 0.9%
- Sodium Chloride 0.9% is a crystalloid solution used to rehydrate fasted patients, treat mild hypotension, and hypovolaemia.
- It can cause swelling, oedema, and renal damage if too much is given.
Oxygen
- Oxygen is administered via a face mask to prevent hypoxia and maintain oxygen saturations above 94%.
- It can be used as a carrier gas for volatile agents, such as sevoflurane.
- Respiratory failure can occur if the flow and percentage are too high.
Alfentanil
- Controlled drug that must be stored in a locked cupboard with access restricted to ODP
- Records of dose administered, used, and wasted must be kept and countersigned by an anaesthetist
- Short-acting opioid used for short procedures, administered via IV
- Completely absorbed by the body, with effects occurring immediately
- 92% bound to proteins in the body
- Metabolized by the liver, with 1% unchanged in urine
- Rapidly excreted in urine due to short half-life
- Typical dose: 30-50mcg/kg for general anaesthesia, additional doses: 15mcg/kg for short procedures
- Side effects: arrhythmias, confusion, constipation, euphoria, headaches, nausea, respiratory depression
- Contraindications: elderly, hypotension, hypothyroidism, COPD, drug addictions
Atracurium
- Non-depolarising neuromuscular blocking agent used to facilitate endotracheal intubation
- Administered via IV as a single bolus or infusion
- Onset of action: around 2 minutes
- Acetylcholine antagonist, blocking nicotinic receptors in the postsynaptic membrane
- Metabolism: 45% non-enzymatic degradation, rest metabolized by plasma enzymes
- Recommended initial dose: 300-600mcg/kg for intubation in adults
- Side effects: flushing, hypotension, tachycardia, bronchospasm
- Contraindications: cardiovascular disease, hypothermia
Sevoflurane
- Inhalation agent used for induction and maintenance of general anaesthesia
- Administered via inhalation, distributed by lungs, and enters bloodstream
- Onset rate depends on concentration and pulmonary blood flow
- Metabolized into inorganic fluoride and HFIP, excreted via expiration
- Administered in two stages: induction (up to 8%) and maintenance (0.5-3%)
- Can cause malignant hyperthermia, increases intracranial pressure
- Side effects: arrhythmias, agitation, apnea, hypertension, hypotension, vomiting
- Contraindications: pregnancy, as it crosses the blood-brain barrier and can depress foetal heart rate
Sodium Chloride 0.9%
- Crystalloid solution stored in pharmacy cupboard
- Administered IV to offset hypotension due to fluid and blood loss
- Rehydrates fasted patients, treats mild hypotension and hypovolaemia
- Can cause: swelling, oedema, and renal damage if too much is given
Oxygen
- Administered via face mask
- Prevents hypoxia, maintains oxygen saturations above 94%
- Can be used as a carrier gas for volatile agents (e.g., Sevoflurane)
- Respiratory failure if flow and percentage are too high
- Stored in cylinders in safe spaces away from electrical equipment due to fire hazard
Alfentanil
- Controlled drug that must be stored in a locked cupboard with access restricted to ODP
- Records of dose administered, used, and wasted must be kept and countersigned by an anaesthetist
- Short-acting opioid used for short procedures, administered via IV
- Completely absorbed by the body, with effects occurring immediately
- 92% bound to proteins in the body
- Metabolized by the liver, with 1% unchanged in urine
- Rapidly excreted in urine due to short half-life
- Typical dose: 30-50mcg/kg for general anaesthesia, additional doses: 15mcg/kg for short procedures
- Side effects: arrhythmias, confusion, constipation, euphoria, headaches, nausea, respiratory depression
- Contraindications: elderly, hypotension, hypothyroidism, COPD, drug addictions
Atracurium
- Non-depolarising neuromuscular blocking agent used to facilitate endotracheal intubation
- Administered via IV as a single bolus or infusion
- Onset of action: around 2 minutes
- Acetylcholine antagonist, blocking nicotinic receptors in the postsynaptic membrane
- Metabolism: 45% non-enzymatic degradation, rest metabolized by plasma enzymes
- Recommended initial dose: 300-600mcg/kg for intubation in adults
- Side effects: flushing, hypotension, tachycardia, bronchospasm
- Contraindications: cardiovascular disease, hypothermia
Sevoflurane
- Inhalation agent used for induction and maintenance of general anaesthesia
- Administered via inhalation, distributed by lungs, and enters bloodstream
- Onset rate depends on concentration and pulmonary blood flow
- Metabolized into inorganic fluoride and HFIP, excreted via expiration
- Administered in two stages: induction (up to 8%) and maintenance (0.5-3%)
- Can cause malignant hyperthermia, increases intracranial pressure
- Side effects: arrhythmias, agitation, apnea, hypertension, hypotension, vomiting
- Contraindications: pregnancy, as it crosses the blood-brain barrier and can depress foetal heart rate
Sodium Chloride 0.9%
- Crystalloid solution stored in pharmacy cupboard
- Administered IV to offset hypotension due to fluid and blood loss
- Rehydrates fasted patients, treats mild hypotension and hypovolaemia
- Can cause: swelling, oedema, and renal damage if too much is given
Oxygen
- Administered via face mask
- Prevents hypoxia, maintains oxygen saturations above 94%
- Can be used as a carrier gas for volatile agents (e.g., Sevoflurane)
- Respiratory failure if flow and percentage are too high
- Stored in cylinders in safe spaces away from electrical equipment due to fire hazard
Alfentanil
- Controlled drug that must be stored in a locked cupboard with access restricted to ODP
- Records of dose administered, used, and wasted must be kept and countersigned by an anaesthetist
- Short-acting opioid used for short procedures, administered via IV
- Completely absorbed by the body, with effects occurring immediately
- 92% bound to proteins in the body
- Metabolized by the liver, with 1% unchanged in urine
- Rapidly excreted in urine due to short half-life
- Typical dose: 30-50mcg/kg for general anaesthesia, additional doses: 15mcg/kg for short procedures
- Side effects: arrhythmias, confusion, constipation, euphoria, headaches, nausea, respiratory depression
- Contraindications: elderly, hypotension, hypothyroidism, COPD, drug addictions
Atracurium
- Non-depolarising neuromuscular blocking agent used to facilitate endotracheal intubation
- Administered via IV as a single bolus or infusion
- Onset of action: around 2 minutes
- Acetylcholine antagonist, blocking nicotinic receptors in the postsynaptic membrane
- Metabolism: 45% non-enzymatic degradation, rest metabolized by plasma enzymes
- Recommended initial dose: 300-600mcg/kg for intubation in adults
- Side effects: flushing, hypotension, tachycardia, bronchospasm
- Contraindications: cardiovascular disease, hypothermia
Sevoflurane
- Inhalation agent used for induction and maintenance of general anaesthesia
- Administered via inhalation, distributed by lungs, and enters bloodstream
- Onset rate depends on concentration and pulmonary blood flow
- Metabolized into inorganic fluoride and HFIP, excreted via expiration
- Administered in two stages: induction (up to 8%) and maintenance (0.5-3%)
- Can cause malignant hyperthermia, increases intracranial pressure
- Side effects: arrhythmias, agitation, apnea, hypertension, hypotension, vomiting
- Contraindications: pregnancy, as it crosses the blood-brain barrier and can depress foetal heart rate
Sodium Chloride 0.9%
- Crystalloid solution stored in pharmacy cupboard
- Administered IV to offset hypotension due to fluid and blood loss
- Rehydrates fasted patients, treats mild hypotension and hypovolaemia
- Can cause: swelling, oedema, and renal damage if too much is given
Oxygen
- Administered via face mask
- Prevents hypoxia, maintains oxygen saturations above 94%
- Can be used as a carrier gas for volatile agents (e.g., Sevoflurane)
- Respiratory failure if flow and percentage are too high
- Stored in cylinders in safe spaces away from electrical equipment due to fire hazard
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.