Pharmacology quiz

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