Pharmacology Proctored ATI Study Guide
Chapter 1: Pharmacokinetics and Routes of Administration
• Absorption
▪ 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)
o Sublingual/buccal
▪ Quick absorption systemically through highly vascular mucous
membranes
o Inhalation via mouth/nose
▪ Rapid absorption through alveolar capillary networks
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
• 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
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.
, 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
• Antagonist: blocks
• 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
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.
, ▪ Insert beyond internal sphincter
▪ 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.
▪ Do not reference or include report in clients medical record
, ▪ Med errors relate to systems, procedures, product design, or practice
patterns. Report all errors to help avoid similar errors in future.
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.
▪ Prevention: carefully select site and size of catheter, secure the catheter.
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
o Cellulitis
o Fluid overload
Chapter 1: Pharmacokinetics and Routes of Administration
• Absorption
▪ 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)
o Sublingual/buccal
▪ Quick absorption systemically through highly vascular mucous
membranes
o Inhalation via mouth/nose
▪ Rapid absorption through alveolar capillary networks
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
• 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
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.
, 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
• Antagonist: blocks
• 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
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.
, ▪ Insert beyond internal sphincter
▪ 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.
▪ Do not reference or include report in clients medical record
, ▪ Med errors relate to systems, procedures, product design, or practice
patterns. Report all errors to help avoid similar errors in future.
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.
▪ Prevention: carefully select site and size of catheter, secure the catheter.
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
o Cellulitis
o Fluid overload
