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
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
Sublingual/buccal
Quick absorption systemically through highly vascular mucousmembranes
Must make sure it is fully absorbed before you eat or drink
Inhalation via mouth/nose
Rapid absorption through alveolar capillary networks
Metered-dose inhaler: shake and press, inhale for 3-5 seconds andthen hold for 10 seconds before
exhaling
Dry powder: DO NOT SHAKE
Intradermal, topical
Slow, gradual absorption
SQ/IM
Highly soluble meds have rapid absorption (10-30min), poorlysoluble have slower absorption
Blood perfusion at site of injection affect absorption
IV
Immediate and complete
20 gauge – standard
Distribution
Transportation of meds to sites of action by body fluids
Plasma binding protein: meds compete for protein binding sites within bloodstream, primarily
albumin. The ability of med to bind to protein canaffect how much med will leave and travel to
target tissues.
Metabolism
Primarily occurs in the liver but can take place in the kidney
Factors that influence metabolism:
Age (infants/older adults require smaller doses)
First pass effect: liver inactivates some meds on first pass through andthus require sublingual or IV
route (may need higher dose)
Excretion
Eliminated through the kidneys
Kidney dysfunction can result in elevated levels of medications.
Med Response
,o Maintain plasma levels between minimum effective concentration and thetoxic concentration:
Therapeutic index (TI)
High TI has a wide safety margin.
Low TI requires monitoring of serum levels; higher risk of toxicity
Tough levels: obtain immediately before next dose.
Half-life
Time it takes a medication level to drop in the body by 50%.
Short vs long half-life: long half-life has greater risk for med accumulation inbody.
Agonist: enhance/produces an action
Antagonist: blocks the action
Routes of admin:
Oral/Enteral:
90 degrees upright
do not mix with large amounts of food
lean chin in to help facilitate swallowing
Sublingual/buccal
Keep med in place until completely dissolved
Transdermal
Wash skin with soap and water then dry it thoroughly before placingpatch. Place patch on hairless
area and rotate sites to prevent irritation.
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.
Ears:
Have client lay on unaffected side.
Up and out for adults
Down and back for children
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
,NG/Gastrostomy tubes
To prevent clogging flush tube before and after each med with 15-30ml of warm sterile water.
Suppositories:
Left lateral sims position.
Remain flat or left lateral for 5 min after insertion.
Intradermal:
Used for allergy testing
Used for tb testing
Small amount of solution (no more than 0.1ml)
10-15-degree angle bevel up.
Z-track: for iron
Chapter 2: Safe Med Admin and Error Reduction
Types of Prescriptions:
Routine/standard: regularly scheduled meds
Single/one time: asap or a specific time
Stat: once and immediately
PRN: as needed
Standing: specific circumstances or specific units: ex: heparin protocol
Taking a phone prescription:
Have 2nd nurse on line if possible
Read-back prescription
Verify and sign within 24 hours
Med rec:
o Take place at admission, transfer of clients, and discharge.
RIGHTS OF SAFE MED ADMIN:
Right client
Right med
Right dose
Right time
Right route
Right documentation
Right client education
Right to refuse
Right assessment
Right evaluation
Evaluation
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.
, 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
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.
Extravasation
Findings: pain, burning, redness, and swelling.
Treatment: stop infusion, place antidote before removing catheter ifthere is one, notify provider.
Hematoma
Elevate extremity, use warm compress
Catheter embolus
Missing catheter tip after discontinuation. Place tourniquet high onextremity, surgical removal.
Phlebitis/thrombophlebitis
Red line up the arm with palpable band at vein site
Symptoms - edema, throbbing, paining, burning, increased skin temp
Chapter 1: Pharmacokinetics and Routes of Administration
Absorption (depends on route)
Route of admin affects the rate and amount of absorption
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
Sublingual/buccal
Quick absorption systemically through highly vascular mucousmembranes
Must make sure it is fully absorbed before you eat or drink
Inhalation via mouth/nose
Rapid absorption through alveolar capillary networks
Metered-dose inhaler: shake and press, inhale for 3-5 seconds andthen hold for 10 seconds before
exhaling
Dry powder: DO NOT SHAKE
Intradermal, topical
Slow, gradual absorption
SQ/IM
Highly soluble meds have rapid absorption (10-30min), poorlysoluble have slower absorption
Blood perfusion at site of injection affect absorption
IV
Immediate and complete
20 gauge – standard
Distribution
Transportation of meds to sites of action by body fluids
Plasma binding protein: meds compete for protein binding sites within bloodstream, primarily
albumin. The ability of med to bind to protein canaffect how much med will leave and travel to
target tissues.
Metabolism
Primarily occurs in the liver but can take place in the kidney
Factors that influence metabolism:
Age (infants/older adults require smaller doses)
First pass effect: liver inactivates some meds on first pass through andthus require sublingual or IV
route (may need higher dose)
Excretion
Eliminated through the kidneys
Kidney dysfunction can result in elevated levels of medications.
Med Response
,o Maintain plasma levels between minimum effective concentration and thetoxic concentration:
Therapeutic index (TI)
High TI has a wide safety margin.
Low TI requires monitoring of serum levels; higher risk of toxicity
Tough levels: obtain immediately before next dose.
Half-life
Time it takes a medication level to drop in the body by 50%.
Short vs long half-life: long half-life has greater risk for med accumulation inbody.
Agonist: enhance/produces an action
Antagonist: blocks the action
Routes of admin:
Oral/Enteral:
90 degrees upright
do not mix with large amounts of food
lean chin in to help facilitate swallowing
Sublingual/buccal
Keep med in place until completely dissolved
Transdermal
Wash skin with soap and water then dry it thoroughly before placingpatch. Place patch on hairless
area and rotate sites to prevent irritation.
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.
Ears:
Have client lay on unaffected side.
Up and out for adults
Down and back for children
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
,NG/Gastrostomy tubes
To prevent clogging flush tube before and after each med with 15-30ml of warm sterile water.
Suppositories:
Left lateral sims position.
Remain flat or left lateral for 5 min after insertion.
Intradermal:
Used for allergy testing
Used for tb testing
Small amount of solution (no more than 0.1ml)
10-15-degree angle bevel up.
Z-track: for iron
Chapter 2: Safe Med Admin and Error Reduction
Types of Prescriptions:
Routine/standard: regularly scheduled meds
Single/one time: asap or a specific time
Stat: once and immediately
PRN: as needed
Standing: specific circumstances or specific units: ex: heparin protocol
Taking a phone prescription:
Have 2nd nurse on line if possible
Read-back prescription
Verify and sign within 24 hours
Med rec:
o Take place at admission, transfer of clients, and discharge.
RIGHTS OF SAFE MED ADMIN:
Right client
Right med
Right dose
Right time
Right route
Right documentation
Right client education
Right to refuse
Right assessment
Right evaluation
Evaluation
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.
, 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
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.
Extravasation
Findings: pain, burning, redness, and swelling.
Treatment: stop infusion, place antidote before removing catheter ifthere is one, notify provider.
Hematoma
Elevate extremity, use warm compress
Catheter embolus
Missing catheter tip after discontinuation. Place tourniquet high onextremity, surgical removal.
Phlebitis/thrombophlebitis
Red line up the arm with palpable band at vein site
Symptoms - edema, throbbing, paining, burning, increased skin temp
