Pharmacology quiz
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Questions and Answers

What is the primary reason for maintaining the potency and effectiveness of all drugs in perioperative care?

  • To ensure the quality of care provided to patients (correct)
  • To comply with the Controlled Drugs Regulations
  • To reduce the risk of administering the wrong drug
  • To prevent the misuse of controlled drugs
  • Which of the following drugs requires refrigeration to preserve its efficacy and therapeutic benefits?

  • Atracurium (correct)
  • Morphine
  • Alfentanil
  • Fentanyl
  • Why is it important to have an efficient organisation of drugs, especially those with similar labelling or packaging?

  • To comply with the Controlled Drugs Regulations
  • To reduce the risk of administering the wrong drug (correct)
  • To prevent the misuse of controlled drugs
  • To ensure the quality of care provided to patients
  • What is the primary purpose of the Controlled Drugs (Supervision of Management) Regulations (2013)?

    <p>To regulate the storage, record keeping, and disposal of controlled drugs</p> Signup and view all the answers

    Who is responsible for adhering to the 6 R's framework prior to administering medication to patients?

    <p>All healthcare professionals, including ODPs</p> 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?

    <p>Two</p> Signup and view all the answers

    What is the purpose of recording the disposal of controlled drugs in the controlled drugs book?

    <p>To prevent misuse of controlled drugs</p> Signup and view all the answers

    What is the primary purpose of the 6 R's framework?

    <p>To reduce the risk of administering the wrong drug</p> Signup and view all the answers

    What is the role of the HCPC in relation to controlled drug safety?

    <p>Recording the presence of individuals during the checking process</p> Signup and view all the answers

    What is the consequence of administering the wrong drug to patients?

    <p>Severe impact on patients and legal consequences for healthcare professionals</p> Signup and view all the answers

    Why is it crucial to confirm the patient's identity before administering drugs?

    <p>To avoid administering drugs to the wrong patient</p> Signup and view all the answers

    What is the purpose of labelling syringes in the administration of drugs?

    <p>To prevent confusion about which drugs are being administered</p> Signup and view all the answers

    What is the primary site of metabolism for propofol?

    <p>Liver</p> Signup and view all the answers

    What is the significance of using gloves when handling medications?

    <p>To prevent cross-contamination and infections</p> Signup and view all the answers

    What is the primary effect of propofol on the cardiovascular system?

    <p>Decreases blood pressure and cardiac output</p> Signup and view all the answers

    How is propofol primarily administered?

    <p>Intravenously</p> Signup and view all the answers

    What percentage of propofol is bound in the plasma?

    <p>Up to 98%</p> Signup and view all the answers

    What is the primary route of excretion for propofol?

    <p>Urine</p> Signup and view all the answers

    What is the significance of confirming allergies with the patient before administering drugs?

    <p>To avoid any reactions that may negatively affect a patient's health</p> Signup and view all the answers

    What is pharmacokinetics defined as?

    <p>How the body interacts with the drug</p> Signup and view all the answers

    What is the primary mechanism by which propofol inhibits the respiratory system?

    <p>Depression of the chemoreceptor response</p> Signup and view all the answers

    What is the recommended caution when administering propofol to patients with hypovolemia?

    <p>Exercise caution due to the risk of vasodilation</p> Signup and view all the answers

    What is the bioavailability of ondansetron when absorbed by the gastrointestinal tract?

    <p>50-70%</p> Signup and view all the answers

    What is the maximum dose of ondansetron recommended for IV administration?

    <p>16mg</p> Signup and view all the answers

    What is the primary mechanism by which alfentanil is metabolized?

    <p>Metabolism by the liver</p> Signup and view all the answers

    What is the typical dose of alfentanil for general anaesthesia?

    <p>30-50mcg/kg</p> Signup and view all the answers

    What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?

    <p>Risk of respiratory depression</p> Signup and view all the answers

    What is the primary storage requirement for alfentanil?

    <p>Store in a locked cupboard</p> Signup and view all the answers

    What is the primary reason for the rapid excretion of alfentanil in the urine?

    <p>Due to its short half-life</p> Signup and view all the answers

    What is the primary concern when using ondansetron in combination with other serotonergic medications?

    <p>Risk of serotonin syndrome</p> Signup and view all the answers

    What percentage of atracurium metabolism is non-enzymatic?

    <p>45%</p> Signup and view all the answers

    What is the recommended initial dose of atracurium for intubation in adults?

    <p>300-600mcg/kg</p> Signup and view all the answers

    What is the main reason for caution when using atracurium in patients with hypothermia?

    <p>Prolongation of the drug's activity</p> Signup and view all the answers

    What is the primary route of excretion for sevoflurane?

    <p>Lungs</p> Signup and view all the answers

    What is the maximum concentration of sevoflurane used during the induction phase?

    <p>8%</p> Signup and view all the answers

    What is a potential complication of using sevoflurane in patients with head injuries?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the primary use of sodium chloride 0.9% in this scenario?

    <p>To treat hypovolaemia</p> Signup and view all the answers

    What is the minimum oxygen saturation level to be maintained?

    <p>94%</p> Signup and view all the answers

    What is the risk associated with storing oxygen cylinders near electrical equipment?

    <p>Fire hazard</p> Signup and view all the answers

    What is the primary method of administering alfentanil?

    <p>Intravenous infusion</p> Signup and view all the answers

    What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?

    <p>45%</p> Signup and view all the answers

    What is the primary reason for caution when using atracurium in patients with cardiovascular disease?

    <p>Risk of hypotension</p> Signup and view all the answers

    What is the maximum concentration of sevoflurane used during the induction phase?

    <p>8%</p> Signup and view all the answers

    What is the primary route of excretion for sevoflurane?

    <p>Lungs via expiration</p> Signup and view all the answers

    What is the primary purpose of administering sodium chloride 0.9% in this scenario?

    <p>To treat hypovolaemia</p> Signup and view all the answers

    What is the minimum oxygen saturation level to be maintained?

    <p>94%</p> Signup and view all the answers

    What is the risk associated with storing oxygen cylinders near electrical equipment?

    <p>Fire hazard</p> Signup and view all the answers

    What is the primary concern when using sevoflurane in patients with head injuries?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the recommended initial dose of atracurium for intubation in adults?

    <p>300-600 mcg/kg</p> Signup and view all the answers

    What is the primary mechanism of action of atracurium?

    <p>Blocking the nicotinic receptors</p> Signup and view all the answers

    What is the primary mechanism by which alfentanil is metabolized in the body?

    <p>Liver enzymes</p> Signup and view all the answers

    What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the typical dose of atracurium for endotracheal intubation in adults?

    <p>1-2mg/kg</p> Signup and view all the answers

    What is the primary route of excretion for alfentanil?

    <p>Urinary excretion</p> Signup and view all the answers

    What is the primary storage requirement for alfentanil?

    <p>Locked cupboard with limited access</p> Signup and view all the answers

    What is the protein binding extent of alfentanil in the body?

    <p>92%</p> Signup and view all the answers

    What is the typical onset of action for atracurium?

    <p>2 minutes</p> Signup and view all the answers

    What is the primary reason for the rapid excretion of alfentanil in the urine?

    <p>Short half-life</p> Signup and view all the answers

    What is the primary concern when using alfentanil in patients with hypothyroidism?

    <p>Increased risk of respiratory depression</p> Signup and view all the answers

    What is the typical dose of alfentanil for general anaesthesia?

    <p>30-50mcg/kg</p> Signup and view all the answers

    What is the primary reason for storing alfentanil in a locked cupboard?

    <p>To comply with the Controlled Drugs (Supervision of Management) Regulations (2013)</p> Signup and view all the answers

    What percentage of alfentanil is bound to proteins in the body?

    <p>92%</p> Signup and view all the answers

    What is the primary route of excretion for alfentanil?

    <p>Urine</p> Signup and view all the answers

    What is the typical dose of alfentanil for general anaesthesia?

    <p>30-50mcg/kg</p> Signup and view all the answers

    What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the primary mechanism of action of atracurium?

    <p>Non-depolarising neuromuscular blocking agent</p> Signup and view all the answers

    What is the onset of action of atracurium?

    <p>Within 2 minutes</p> Signup and view all the answers

    What is the primary reason for caution when using atracurium in patients with hypothermia?

    <p>Risk of prolonged neuromuscular block</p> Signup and view all the answers

    What percentage of atracurium metabolism is non-enzymatic?

    <p>90%</p> Signup and view all the answers

    What is the recommended initial dose of atracurium for intubation in adults?

    <p>0.5mg/kg</p> Signup and view all the answers

    What percentage of atracurium metabolism is accounted for by non-enzymatic degradation?

    <p>45%</p> Signup and view all the answers

    What is the primary purpose of administering sodium chloride 0.9% in this scenario?

    <p>To offset hypotension due to fluid and blood loss</p> Signup and view all the answers

    What is the maximum concentration of sevoflurane used during the induction phase?

    <p>8%</p> Signup and view all the answers

    What is the primary route of excretion for sevoflurane?

    <p>Lungs via expiration</p> Signup and view all the answers

    What is the primary concern when using sevoflurane in patients with head injuries?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the recommended initial dose of atracurium for intubation in adults?

    <p>300-600mcg/kg</p> Signup and view all the answers

    What is the primary mechanism of action of atracurium?

    <p>Acts as a competitive antagonist at the nicotinic receptor</p> Signup and view all the answers

    What is the main reason for caution when using atracurium in patients with hypothermia?

    <p>Prolonged activity of the drug</p> Signup and view all the answers

    What is the primary purpose of administering oxygen in this scenario?

    <p>To prevent hypoxia and maintain oxygen saturation above 94%</p> Signup and view all the answers

    What is the risk associated with storing oxygen cylinders near electrical equipment?

    <p>Fire hazard</p> Signup and view all the answers

    What percentage of atracurium metabolism is non-enzymatic?

    <p>45%</p> Signup and view all the answers

    What is the primary concern when using sevoflurane in patients with head injuries?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What is the primary mechanism of action of alfentanil?

    <p>Blockage of opioid receptors</p> Signup and view all the answers

    Why is it important to be cautious when administering atracurium to patients with hypothermia?

    <p>It slows down the metabolism of atracurium</p> Signup and view all the answers

    What is the primary route of excretion for sevoflurane?

    <p>Lungs</p> Signup and view all the answers

    What is the primary route of excretion for alfentanil?

    <p>Urine</p> Signup and view all the answers

    What is the recommended initial dose of atracurium for intubation in adults?

    <p>300-600mcg/kg</p> Signup and view all the answers

    What is the typical dose of alfentanil for general anaesthesia?

    <p>30-50mcg/kg</p> Signup and view all the answers

    What is the primary concern when combining alfentanil with other drugs, such as benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the primary purpose of administering sodium chloride 0.9% in this scenario?

    <p>To treat hypovolemia</p> Signup and view all the answers

    What is the primary storage requirement for alfentanil?

    <p>Locked cupboard</p> Signup and view all the answers

    What is the minimum oxygen saturation level to be maintained?

    <p>94%</p> Signup and view all the answers

    What is the primary mechanism of action of atracurium?

    <p>Relaxation of the muscles</p> Signup and view all the answers

    What is the risk associated with storing oxygen cylinders near electrical equipment?

    <p>Fire hazard</p> Signup and view all the answers

    What is the primary route of administration for atracurium?

    <p>Intravenous</p> Signup and view all the answers

    What is the primary method of administering atracurium?

    <p>Intravenously</p> Signup and view all the answers

    What is the primary concern when using atracurium in patients with hypothermia?

    <p>Prolonged muscle relaxation</p> Signup and view all the answers

    What is the primary mechanism of action of atracurium?

    <p>Binding to nicotinic receptors</p> Signup and view all the answers

    What is the primary reason for the rapid excretion of alfentanil in the urine?

    <p>Short half-life</p> Signup and view all the answers

    What percentage of alfentanil binds to proteins in the body?

    <p>92%</p> 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

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