NURSING
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.
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.
