Pharmacology Proctored ATI Study Guide

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

, 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

, 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.

, 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