Exam III Pharmacology (8-9, 11)

Androgens

Hormones produced primarily by the adrenal glands, which include testosterone.

Endometriosis

Condition in which the endometrial lining grows outside the uterus.

Fibrocystic breast changes

Alterations in breast tissue that cause noncancerous lumps.

Palliatives

Medications or treatments to alleviate the symptoms without curing the disease.

What are hormones?

Chemicals released by endocrine glands into the bloodstream that regulate functions such as reproduction, growth, and metabolism.

What are the four main groups of hormonal action effects on the body?

Regulation of internal chemical balance and volume, response to environmental changes, growth and development, and reproduction.

What is the role of the endocrine system?

To communicate by sending chemical messengers (hormones) to target cells throughout the body.

What are the two major groups of adrenal cortex hormones?

Glucocorticoids (primarily cortisol) and mineralocorticoids (primarily aldosterone).

What is the function of the pituitary gland?

Regulates the function of other endocrine glands and is vital for reproduction and growth.

What hormone does the pituitary gland produce that is important for labor?

Oxytocin, also known as Pitocin.

What is the significance of epinephrine in surgery?

Epinephrine is used for its vasoconstrictive properties, prolong anesthesia, and is important for maintaining hemostasis during surgical procedures.

What are the main hormones produced by the thyroid gland?

Thyroxine (T4), triiodothyronine (T3), and calcitonin.

What is hypothyroidism and its symptoms?

A condition where the thyroid is underactive, leading to symptoms like fatigue, reduced mental alertness, and slow heart rate. Hashimoto's disease

What is hyperthyroidism and its most common cause?

A condition where the thyroid is overactive, causing symptoms like restlessness and rapid heart rate, commonly caused by Graves' disease.

What is the function of parathyroid hormones?

They regulate calcium levels in the blood and are used for hormone replacement therapy.

What is the largest endocrine gland?

The thyroid gland.

How are steroid hormones classified?

Into glucocorticoids, mineralocorticoids, estrogens, progestogens, and androgens.

What are nonsteroid hormones synthesized from?

Amino acids.

What is hyposecretion and its treatment?

A condition where there is insufficient hormone production, treated with hormone replacement therapy.

What is hypersecretion and its treatment?

A condition where there is excessive hormone production, treated with medications to reduce secretion or surgical gland removal.

What is the role of the pancreas in hormone production?

The pancreas produces insulin and glucagon, which regulate blood sugar levels.

(hint: low sugar = emotion)

What is the importance of understanding hormone administration in surgery?

Surgical technologists must know why hormones are given to ensure patient safety and effective treatment during procedures.

What hormone do parathyroid glands produce?

Parathyroid hormone (PTH)

What is the primary function of parathyroid hormone (PTH)?

To monitor circulating concentrations of calcium ions in the blood.

How many parathyroid glands do most patients have?

90% of patients have 4 parathyroid glands, typically 2 on each side of the thyroid gland.

What is the surgical use of parathyroid hormones?

Parathyroid hormones have no surgical use; they are used for hormone replacement.

What shape are the adrenal glands?

Pyramid-shaped.

What hormones do the adrenal glands produce?

Epinephrine, norepinephrine, and dopamine, collectively known as catecholamines.

What effects do catecholamines have on the body?

They increase heart rate, cardiac muscle contraction, vasoconstriction, blood pressure, respiratory rate, and decrease digestive activity.

What is a contraindication for using epinephrine in local anesthetics?

Epinephrine is contraindicated for injection in areas of limited blood supply, such as fingers or toes.

What is the most important mineralocorticoid?

Aldosterone, which maintains sodium and potassium levels in the blood.

What are glucocorticoids used for?

To prevent organ rejection, treat autoimmune disorders, and reduce inflammation post-operatively.

What are some examples of glucocorticoids?

Prednisone, hydrocortisone, Depo-Medrol (Solu-Medrol), Kenalog, Flonase, and Flovent.

What is the role of the pancreas in the endocrine system?

The pancreas releases insulin and glucagon, regulating glucose metabolism.

What are the two main types of diabetes mellitus?

Type 1 and Type 2 diabetes.

What causes Type 1 diabetes?

An autoimmune disorder that attacks pancreatic cells, preventing insulin production.

How is Type 2 diabetes managed?

Through diet, exercise, or administration of oral anti-diabetic drugs.

What hormones do the ovaries produce?

Estrogen and progesterone.

What are the functions of estrogens?

They are critical for female sex characteristics and have multiple medical uses, including treatment for advanced prostate and breast cancers.

What are androgens?

Male sex hormones produced by the testes.

What is testosterone used to treat?

Hypogonadism, advanced breast cancer in females, endometriosis, and fibrocystic breast disease.

What is the primary function of insulin?

To lower blood glucose levels by promoting the formation of glycogen from glucose.

What does glucagon do?

Stimulates the liver to break down glycogen into glucose, increasing blood glucose levels.

What is the pancreas's role as an exocrine gland?

It is the primary source of digestive enzymes like amylase, lipase, and proteinase.

What is the significance of glucocorticoids in organ transplantation?

They are used to prevent or alleviate the immune response that can lead to organ rejection.

Two of the most common ways to maintain homeostasis. Happens intravenously via IV fluids and medications

1. blood replacement

2. fluid replacement

Three basic classifications of IV Fluids:

1. crystalloids (with or without electrolytes)

2. colloids as volume expanders

3. blood products

Replacement fluids

Replenish losses caused by hemorrhage (in surgery) or vomiting and diarrhea (in the medical setting)

Maintenance fluids

sustain normal fluid and electrolyte balance

60% of total BLANK is made up of fluids, electrolytes, and nonelectrolyte

body weight

Fluids are distributed in two distinct compartments:

1. intracellular fluid

2. extracellular fluid

Major Electrolytes Table

• Sodium Na+

• Chloride Cl–

• Potassium K+

• Calcium Ca++

• Magnesium Mg++

• Phosphate HPO4–

• Others are bicarbonate, sulfate and carbonic acid

Sodium Na+

Controls water in body, maintains fluid, and electrolyte balance

Potassium K+

serves several critical functions in homeostasis. Is needed for neuromuscular function including the heart

Calcium Ca++

Most abundant mineral in body, needed for healthy bones, teeth, and blood clotting process

Na+ Normal Value

135-145 mEq/L

Ca2+ normal value

4.4–5.5 mEq/L

K+ normal value

3.5–5.0 mEq/L

In homeostasis, electrolytes have three main purposes:

1. Controlling the volume of body water by osmotic pressure

2. Maintaining the acid-base balance

3. Serving as essential minerals

Most used IV fluids in surgery are BLANK (which are composed mainly of water with dissolved electrolytes) BLANK, and multiple electrolyte solutions

crystalloids, dextrose solutions

Two reasons to “start” an IV line for the surgical patient

1. Direct access to the circulatory system

2. Replace current fluid losses

0.9% sodium chloride (NaCl)

Who am I?

It is isotonic which means its concentration of dissolved particles is similar to that of plasma and causes no shift in cell fluids

Fluid replacement or simple hydration

1. Most common used in surgery

2. Used when transfusing blood because it does not hemolyze red blood cells (fill with fluid and rupture

Dextrose – a Natural Sugar

(hint glucose)

Who am I?

1. Used for patients who require easily metabolized source of calories

2. Used in trauma and stress of surgery

3. Increases insulin and hypoglycemic requirements

BLANK in normal saline is used for the temporary treatment of circulatory insufficiency and shock from hypovolemia

Dextrose 5%

What is NOT used with blood products because it causes hemolysis (breaking down) of RBCs

Dextrose

Lactated Ringer’s (LR) / Hartmann Solution

Who am I?

This physiologic salt solution is used to replenish the patient’s electrolytes and rehydrate the patient to stimulate renal activity

patients are those at high risk include those with liver disease, Addison disease, severe pH imbalances, shock, or cardiac failure

Normosol-R

May be used to increase circulatory volume in patients with moderate blood loss, does not cause hemolysis

Plasma-Lyte and Isolyte E

Electrolyte-balanced solutions compatible with the pH of blood

angiocath

flexible catheter, or BLANK, is inserted into a vein—usually in the patient’s hand or forearm

Primary IV

BLANK tubing connects to the hub of the IV catheter, and the other end connects to IV solution

Secondary

BLANK lines are used with antibiotics

1. BLANK tubing hangs higher on the IV pole than primary tubing so it infuses first

2. if required for piggyback

Blood volume

BLANK varies with the patient’s body size, amount of adipose tissue, and changes in fluid/electrolyte concentrations

Three main purposes of BLOOD REPLACEMENT

1. Transports oxygen, nutrients, wastes, hormones, and enzymes throughout body

2. Maintains the body’s acid-base balance, temperature, and water content

3. Carries the body’s immune response

Goal of blood replacement (in scheduled surgical procedures)

1. Maintain the circulating volume of blood

2. Also to maintain oxygen-carrying capacity

Blood types are BLANK

inherited

RhoGAM

1. BLANK is given to treat possible blood reactions.

   1. It given to Rh negative mothers who have Rh positive fetus after delivery.

   2. The disease could result in miscarriage in subsequent pregnancies if not treated

Blood Crossmatch

performed to determine compatibility between the donor and the recipient. A sample of the donor RBCs is mixed with the recipient’s serum

In an average adult, circulating blood volume is about BLANK

70 milliliters per kilogram of body mass

hemoglobin

The amount of BLANK—the protein that transports oxygen and carbon dioxide between the lungs and the cells—varies slightly between males and female

hematocrit

Age and gender determine normal levels of BLANK, which is the volume of red blood cells in a given volume of blood

Circulating Volume normal range

1. Female: 4-5 L

2. Male: 5-6 L

Hemoglobin normal range

1. Female: 12-16 g/mL of blood

2. Male: 14-18 g/mL of blood

Hematocrit normal range

1. Female: 35%-46%

2. Male: 40%-52%

Blood consists of two main components:

1. Formed Elements (45%)

2. Plasma (55%)

Erythrocytes

BLANK (red blood cells [RBCs]) *BLANK make up more than 99% of the body’s formed elements

Leukocytes

BLANK (white blood cells [WBCs]) provide protection against foreign microbes

Platelets

BLANK- mediate the clotting process

Hypovolemia (low circulating blood volume)

Who am I?

• Most common indication-circulatory shock

• Seen most frequently in trauma or vascular procedures

• BLANK can be further complicated by the anesthetic, which may enhance the effects of hemorrhage

Restoration

BLANK (of the oxygen carrying capacity)

• Seen in anemic patients

Maintenance

BLANK (of clotting properties)

• Seen in hemophiliac patients

Directed or Designated

Donor blood from family or friends for a specific patient

Homologous Donation

Use of donor blood

Autologous donation

Patient donating his or her own blood before surgery

Autotransfusion

Patient’s own blood being collected and used during or after surgery

BLANK is rarely used for transfusion today.

Whole Blood

Cryoprecipitate

BLANK is a plasma component used to treat hemophilia A, Von Willebrand disease, and lack of factor XIII

Packed Red Blood Cells (PRBCs)

Most common transfusion of donor blood in surgery

1 unit =350 ml/unit; will raise Hgb 1g/dL & Hct approximately 3%

Fresh Frozen Plasma (FFP)

(hint number of letters)

Given when clotting factors are needed and to increase circulating volume

1. Stored as fresh-frozen to reserve clotting factors

2. Must be used within 6 hours of thawing

when are platelets administered?

Administered during surgery when large amounts of donor blood had been given

"Cell Saver"/Autotransfusion

Form of autologous donation used intraoperatively and postoperatively