Pharmacology Proctored ATI Study Guide

Chapter 1: Pharmacokinetics and Routes of Administration

• Absorption (depends on route)

§ Route of admin affects the rate and amount of absorption

o Oral:

§ GI pH and emptying time

§ Presence of food in the stomach or intestines

§ Form of meds (liquid/XR)

§ Sit upright or put your chin to your chest to aid in swallowing

o Sublingual/buccal

§ Quick absorption systemically through highly vascular mucous

membranes

§ Must make sure it is fully absorbed before you eat or drink

o Inhalation via mouth/nose

§ Rapid absorption through alveolar capillary networks

§ Metered-dose inhaler: shake and press, inhale for 3-5 seconds and

then hold for 10 seconds before exhaling

§ Dry powder: DO NOT SHAKE

o Intradermal, topical

§ Slow, gradual absorption

o SQ/IM

§ Highly soluble meds have rapid absorption (10-30min), poorly

soluble have slower absorption

§ Blood perfusion at site of injection affect absorption

o IV

§ Immediate and complete

§ 20 gauge – standard

• Distribution

o Transportation of meds to sites of action by body fluids

o Plasma binding protein: meds compete for protein binding sites within

bloodstream, primarily albumin. The ability of med to bind to protein can

affect how much med will leave and travel to target tissues.

• Metabolism

o Primarily occurs in the liver but can take place in the kidney

o Factors that influence metabolism:

§ Age (infants/older adults require smaller doses)

§ First pass effect: liver inactivates some meds on first pass through and

thus require sublingual or IV route (may need higher dose)

• Excretion

o Eliminated through the kidneys

o Kidney dysfunction can result in elevated levels of medications.

• Med Response

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o Maintain plasma levels between minimum effective concentration and the

toxic concentration:

• Therapeutic index (TI)

o High TI has a wide safety margin.

o Low TI requires monitoring of serum levels; higher risk of toxicity

o Tough levels: obtain immediately before next dose.

• Half-life

o Time it takes a medication level to drop in the body by 50%.

o Short vs long half-life: long half-life has greater risk for med accumulation in

body.

• Agonist: enhance/produces an action

• Antagonist: blocks the action

• Routes of admin:

o Oral/Enteral:

§ 90 degrees upright

§ do not mix with large amounts of food

§ lean chin in to help facilitate swallowing

o Sublingual/buccal

§ Keep med in place until completely dissolved

o Transdermal

§ Wash skin with soap and water then dry it thoroughly before placing

patch. Place patch on hairless area and rotate sites to prevent

irritation.

o Drops:

§ Place drop in center of sac.

§ Avoid placing directly on cornea.

§ If blink repeat process.

§ Apply gentle pressure with finger and a clean facial tissue on the

nasolacrimal duct for 30-60 seconds to prevent systemic absorption.

o Ears:

§ Have client lay on unaffected side.

§ Up and out for adults

§ Down and back for children

o Inhalation:

§ MDI

• Shake vigorously 5-6 times

• Take a deep breath and then exhale

• Slow deep breath for 3-5 seconds from MDI

• Hold breath for 10 seconds after

§ DPI

• DO NOT SHAKE DEVICE

• Place mouthpiece between lips and take a deep breath

• Hold breath for 5-10 seconds

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o NG/Gastrostomy tubes

§ To prevent clogging flush tube before and after each med with 15-

30ml of warm sterile water.

o Suppositories:

§ Left lateral sims position.

§ Remain flat or left lateral for 5 min after insertion.

o Intradermal:

§ Used for allergy testing

§ Used for tb testing

§ Small amount of solution (no more than 0.1ml)

§ 10-15-degree angle bevel up.

o Z-track: for iron

Chapter 2: Safe Med Admin and Error Reduction

• Types of Prescriptions:

o Routine/standard: regularly scheduled meds

o Single/one time: asap or a specific time

o Stat: once and immediately

o PRN: as needed

o Standing: specific circumstances or specific units: ex: heparin protocol

• Taking a phone prescription:

o Have 2nd nurse on line if possible

o Read-back prescription

o Verify and sign within 24 hours

• Med rec:

o Take place at admission, transfer of clients, and discharge.

• RIGHTS OF SAFE MED ADMIN:

o Right client

o Right med

o Right dose

o Right time

o Right route

o Right documentation

o Right client education

o Right to refuse

o Right assessment

o Right evaluation

• Evaluation

o Report all errors and implement corrective measures immediately

§ Complete incident report within time frame the facility specifies

(usually 24 hours) and it should include

• Client id, name and dose of med, time and place of incident,

accurate and objective account of event, who you notified,

what actions you took, your signature.

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Chapter 3: Dosage Calculation

• 1kg=1000mg

• 1oz=30mL

• 1L=1000mL

Chapter 4: IV Therapy

• Rapid and precise

• Circulatory overload is possible if too large or too rapid of an infusion

• Admin can irritate vein

• Can lead to sepsis if aseptic technique is broken

• Distal veins on nondominant hand first

• Write date/time, document size/site/appearance

• Flush every 8-12 hours when not in use

• Avoid tourniquets in older adults

• Hold hand below heart

• Change every 72 hours

• Change tubing every 24 hours

• Changes fluids every 24 hours

• Wipe all ports with alcohol before using or inserting a syringe

• Complications

o Infiltration

§ Findings: pallor, local swelling at site, decreased skin temp around

site, damp dressing

§ Treatment: stop infusion and remove catheter, elevate extremity,

encourage active range of motion, apply a cold or warm compress

depending on type of solution that infiltrated, check with provider to

determine whether the IV is still needed.

o Extravasation

§ Findings: pain, burning, redness, and swelling.

§ Treatment: stop infusion, place antidote before removing catheter if

there is one, notify provider.

o Hematoma

§ Elevate extremity, use warm compress

o Catheter embolus

§ Missing catheter tip after discontinuation. Place tourniquet high on

extremity, surgical removal.

o Phlebitis/thrombophlebitis

§ Red line up the arm with palpable band at vein site

§ Symptoms - edema, throbbing, paining, burning, increased skin temp

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