This document provides information on medication handling for anesthesia technicians. It discusses drug sources and properties, legal drug classifications including controlled substances, prescribed and over-the-counter medications. It also covers medication names, abbreviations, handling techniques, ASA classifications, depth of anesthesia, and phases of general anesthesia. The anesthesia technologist is responsible for knowing this basic medication information when handling drugs in the surgical setting.

1. MEDICATION HANDLING
ANES 1501
INTRODUCTION TO ANESTHESIA TECHNOLOGY
COLLEGE OF DUPAGE

2. DRUG
A substance used as medicine for the diagnosis, treatment, cure, mitigation, or prevention
(prophylaxis) of disease or a condition
Drugs are derived from 5 main sources

3. DRUG SOURCES
Plants - Morphine and digitalis
Animals – primarily hormones – heparin sodium and thrombin. Drugs obtained from
cows=bovine, porcine=pigs
Minerals – from the earth-calcium, iron, magnesium, gold, silver, zinc

4. Other Drug Sources
Laboratory synthesis – majority of drugs used today
Synthetic drugs – manufactured totally from laboratory chemicals,
ie-Demerol
Semisynthetic – begins with a natural substance, which is then
chemically altered, ie-the aminogylcoside group of antibiotics.
Biotechnology – genetic engineering, ie-hepatitis B vaccine. New
technology is referred to as recombinant technology.

5. DRUG PROPERTIES
PRARMACODYNAMICS
The interaction of drug molecules with the target cells of living tissue. The resulting action is
both biochemical and physiological
Medication action – drug interaction may be intentional (beneficial) or undesirable
(detrimental)

6. MEDICATION EFFECTS
Therapeutic effect- the concentration or dose of a medication used to produce the desired
result without producing harmful effect.
Side effect – an expected, undesirable but tolerable effect of a medication. These include
symptoms such as dry mouth, constipation, diarrhea, etc.

7. MEDICATION EFFECTS
Adverse effect – undesirable and potentially harmful effect of a
medication that can lead to organ damage or failure. Susceptible
organs include the brain, liver, kidneys and CV system.
Toxic effect – the undesirable and unacceptable effects of a
medication. The effects can include the promotion of growth of
cancerous tumors or the development of birth defects

8. MEDICATION EFFECTS
Tolerance – the reduction in the effect of a medication given at the same dose over a period of
time. The dosage of the medication must be increased in order to demonstrate the desired
effect.
Addiction – a physical or psychological dependency on the effects of medication.

9. DRUG STANDARDS
Medication for use in the US are required to undergo review and
approval by the FDA. Listings and formulas are found in the following
publications.
National Formulary – info on single drugs and formulas; drugs are
listed by generic names
Pharmacopeia of the US (USP) – info on medications currently used
in practices; drug lists by generic names, classifications, & dosages

10. DRUG STANDARDS
American Hospital Formulary Service Index – info arranged in therapeutic or pharmacological
class
Physician’s Desk Reference (PDR) – not official listing, commonly used by physicians for
prescription; alphabetic by brand name

11. LEGAL DRUG CLASSIFICATIONS
The 3 legal drug classifications that are most commonly used are controlled substances,
prescribed medication, and over-the-counter, they are classified according to their principal
action
Controlled substances – those with a high potential to cause psychological and/or physical
dependence and abuse

12. CONTROLLED SUBSTANCES
Schedule I–– they have the highest potential for abuse, with no acceptable
medical use. Examples: heroin, lysergic acid diethlamide (LSD)
Schedule II –– high potential for abuse, but which there is a current approved
medical use. Examples: Fentanyl, Dilaudid, Morphine, Cocaine (topical)
Schedule III – high potential for abuse, less than the drugs or other substances
in schedule I or II. Examples Steroids, Ketamine
Schedule IV– low potential for abuse with accepted medial use. Examples:
Xanax, Valium, Versed

13. CONTROLLED SUBSTANCES
Schedule V–– they have a low potential for abuse relative to the drugs and
other substances in schedule IV and have accepted medicinal use. Examples:
Lyrica and cough suppressants with small amount of codeine

14. PRESCRIBED MEDICATIONS
Prescribed medications are those meds that, if used inappropriately could cause significant
harm to the patient

15. OVER-THE-COUNTER
OTC meds are pharmacologic agents that are prepared in a dosage generally safe to administer
without physician’s direction

16. MEDICATION INFORMATION
The Anesthesia Technologist is responsible for knowing basic info about the meds they handle
on the sterile field, including – names, classifications, action, indications, uses in the surgical
setting and dosages

17. MEDICATION NAMES
Trade, brand or proprietary – name assigned and copyrighted by the
manufacturer
The trade name of the med is capitalized and may be followed by an
R with a circle around it.
Generic – nonproprietary, often shortened version of chemical
name. Use of the generic name often advocated in health care
settings to avoid confusion between medications with similar trade
names
Chemical – precise chemical composition and molecular structure

18. ABBREVIATIONS RELATED TO
MEDICATIONS
The Joint Commission recommends that abbreviations no longer be
used for the following:
Cubic centimeters micrograms
Hour
Daily, twice daily, three times daily, every other day
Magnesium sulfate morphine sulfate
International units units

19. DRUG HANDLING THECHNIQUES
Drug safety is of the utmost concern. Medication errors can be
minimized by knowing policies, procedures and pertinent state and
federal laws.

20. 6 (not 5) Drug Routes
Six basic rights for correct drug handling
• The right patient
• The right dose
• The right time and frequency
• The right documentation, including labeling
• The right drug
• The right route

21. MEDICATION IDENTIFICATION
Drugs come in different packages – ampule, vial, preloaded syringe,
tube.
Label information– name, manufacturer, strength, amount,
expiration date, route of administration, lot number,
handling/storage.

22. ASA CLASSIFICATIONS
The American Society of Anesthesiologists has set forth a
classification system for assessing patient risk, the classes are as
follows:
Class 1 – no organic, physiological, biochemical or psychiatric
disturbance
Class 2 – mild to moderate systemic disease disturbance, history of
asthma, smoker, controlled diabetes, mild obesity, age less than 1 or
greater then 70

23. ASA CLASSIFICATIONS
Class 3 – severe systemic disturbance or disease, angina, post-
myocardial infarction, poorly controlled hypertension, massive
obesity, symptomatic respiratory disease
Class 4 – pt. with severe systemic disease, disorders, that are life
threatening, unstable angina, CHF, debilitating respiratory disease,
hepatorenal failure.

24. ASA CLASSIFICATIONS, cont.
Class 5 – moribund patient with little chance of survival who is
operated on in desperation
Class 6 – brain dead, life support provided, organ procurement
intended
Emergency modifier (E) – applies when doing and emergency
surgery

25. DEPTH OF ANESTHESIA
Stage I – amnesia stage, begins with initial administration of an
anesthetic agent to loss of consciousness
Stage II – consists of the period from the loss of consciousness to the
return of regular breathing and loss of the eyelid reflex. This stage is
often referred toas the excitement or delirium stage.

26. DEPTH OF ANESTHESIA, cont.
Stage III – consists of the period between the onset of regular
breathing and loss of eyelid reflex to the cessation of breathing. This
is know as the surgical anesthesia stage
Stage IV – is referred to as the overdosage stage, dilated and
nonreactive pupils, cessation of respiration and marked
hypotension.

27. PHASES OF GENERAL
ANESTHESIA
Induction phase – induction involves altering the patient’s level of
consciousness from the conscious to the unconscious state. Hearing
is the last sense to leave.
Maintenance phase – surgical intervention takes place during this
phase

28. PHASES OF GENERAL
ANESTHESIA, cont.
Emergence phase – occurs as the surgical intervention is being
completed, the goal is to have the patient as awake as possible at
the end of the surgery. Restoration of the “gag” reflex.
Recovery phase – the period of time during which the pt returns to
the optimum level of consciousness and well being.