1
New ATI
Pharmacology
Study Guide
TIPS: Study the generic names of medications. When in doubt with a food interaction: grape
fruit juice is usually the option. Herbal supplements: Many that start with “G” increase a
patient’s risk of bleeding. Most medications are contraindicated with pregnancy. Not safe to
drink alcohol with MOST medications. Patients in general should never stop medications
abruptly. In general, if dose is missed do not double up on next dose (birth control exception).
DO not chew or crush extended release medications (IMPORTANT). Antibiotics: make sure the
patient finishes their course of therapy, get culture before starting antibiotics (IMPORTANT).
Chapter One: Pharmacokinetics and Routes of Administration
Pharmacokinetics
Four Phases of Pharmacokinetics:
Absorption: How quickly or how well a medication is absorbed depends on the route.
- Oral: more slowly, depends on food in stomach, pH of gastric content. Liquid
absorbs more quickly than extended release
- Sublingual: Absorbed more quickly, placed under the tongue. Mucosa under tongue
is very vascular. Do not eat or drink until medication is completely absorbed.
- Inhalation: Absorption happens very quickly.
- Intradermal/topical: Absorption is slower. Lidocaine patch: slow steady release.
- Subcutaneous/intramuscular: Absorption depends on the solubility of the medication
and the blood perfusion at site
- IV: absorption happens immediately
Distribution: After absorption. Medication travels to the site of action. Medications need binding
proteins in order to be distributed to travel to site. Albumin is a common protein used to bind, if
pt.’s levels are low, will impact medication distribution.
Metabolism: Medication is inactivated or broken down into a less active form by enzymes. Most
happens in the liver. Bowel, lungs, and kidneys can also be involved.
- Infants have immature metabolism which increases risk for toxicity. Older adults
have problems with liver and kidneys which slow down metabolism, leads to higher
risk of toxicity
- First Pass Effect: Oral medications inactivated through first pass through the liver.
May need to give a higher dose for therapeutic effect to be felt
- Excretion: Primarily happens in the kidneys. If not working higher risk for toxicity
Minimum Effective Concentration and Therapeutic Index: Dosing- want to receive a medication
level that is above MEC and but be below level of toxicity. Some medications have a high
therapeutic index and some a low therapeutic index (vancomycin). To do this you take blood
samples of the medication’s trough levels and peak levels.
, 2
Medication Half-life: The time the medication is reduced to 50%. Short half-life: eliminated
quickly. Long half-life: lingers in body and has increased risk of toxicity.
Agonist vs. Antagonist:
Agonist: medication designed to produce an action (morphine: bind to receptors and produce an
action)
Antagonist: medication designed to block an action (naloxone: bind to receptors to block action)
Routes of Administration:
- Oral: May need to mix with a little apple sauce or pudding to help with swallowing.
Patient should sit up right, help with swallowing: tuck chin into chest when swallowing.
Should never crush or chew enteric coated or extended release capsules
- Sublingual: Under the tongue. Do not eat or drink until completely absorbed
- Transdermal: Important to wash the skin with soap and water and dry before putting
patch. Remove old patch before putting new one on, rotate sites to prevent irritation.
Choose hairless area of skin.
- Eye medications: Surgical aseptic technique. Drops: place in the center of the
conjunctival sac. After that put gentle pressure on the nasolacrimal duct for 30-
60 seconds. Never touch bottle to eye
- Ear drops: Place on unaffected sites. Adults: back and up. Children: back and down.
- G tube or NG tube: Flush the tube before and after each medication with 15-30mL
of sterile water. Flush at the end with the same
- Suppositories: Place the patient on left side, place in anus just past the external sphincter
and keep it inside of them for at least 5 minutes
- Inhalation: Metered dose inhaler: shake at least 5-6 times, breathe out, push inhaler,
breathe in 4-5 seconds, then hold breath for 10 seconds before exhaling. Dry powder:
Don’t shake, deep breath, hold
- IM injections: Under 2 years old use vastus lateralis muscle (IMPORTANT). After that
you can also use the ventrogluteal site, dorsal gluteal site or deltoid. Solution volume: 1-
3ml
- Intradermal injections: Low volumes of solutions, no more than 0.1ml, hold needle at a 5-
15 degree angle with bevel up
- Subcutaneous: needle 3/8 to 5/8 inch, 25- or 27-gauge needle and inject at a 45 or 90
degrees if obese.
- Intramuscular injection: needle length 1 to 1 ½ inches, 22 to 25-gauge needle with 90
degree angle. Some use a Z track injection: pull skin, inject needle, remove needle, let go
of skin.
- IV: 20 gauge catheter is standard (fluids, and blood can be given through them),
trauma patients need something bigger (16 gauge catheter). Child and older adults: 22
or 24 gauge catheter. Epidural: between 4th and 5th vertebrae.
Chapter Two: Safe Medication Administration and Error Reduction
, 3
Safe Medication
Administration Prescriptions:
- Routine order/standard prescription: for medications patient needs to take ongoing. As
the nurse, you can give medication 30 minutes before or after the time the medication is
prescribed.
- One time/single prescription: Medication is only given once and is not ongoing
- STAT prescription: Medication that the nurse needs to given right away for an emergency
- PRN prescriptions: As needed, needs to be dose, frequency and what condition
the medication should be given
- Standing prescription: written for specific circumstances on specific units
Components of an Order (IMPORTANT)
Patients name, date and time of prescription, the name of the medication, the dose, the route, the
time and frequency of the medication, and physicians’ signature
Telephone orders: Have second nurse in on the call and read back what you heard the doctor
say, make sure all components are there. Sign off within 24 hours
Medication reconciliation: Gather information about what meds are taken at home. Done at
admission, when transferred to another unit, and at discharge.
Rights of Medication Administration:
- Right patient: correct patient identifiers (name, DOB, medical record number) NOT room
- Right medication
- Right dose
- Right time
- Right route
- Right documentation
- Patients RIGHT to
refusal Written prescriptions:
ISMP: list of abbreviations NOT to use.
Key:
- IU: international units
- U: units
- QOD/QD: every other day, every day
- SC/SQ: subcutaneous injection
Writing dose: “be a leader not a follower” 0.5 = yes .50 = no
Never administer medication someone else has prepared.
New ATI
Pharmacology
Study Guide
TIPS: Study the generic names of medications. When in doubt with a food interaction: grape
fruit juice is usually the option. Herbal supplements: Many that start with “G” increase a
patient’s risk of bleeding. Most medications are contraindicated with pregnancy. Not safe to
drink alcohol with MOST medications. Patients in general should never stop medications
abruptly. In general, if dose is missed do not double up on next dose (birth control exception).
DO not chew or crush extended release medications (IMPORTANT). Antibiotics: make sure the
patient finishes their course of therapy, get culture before starting antibiotics (IMPORTANT).
Chapter One: Pharmacokinetics and Routes of Administration
Pharmacokinetics
Four Phases of Pharmacokinetics:
Absorption: How quickly or how well a medication is absorbed depends on the route.
- Oral: more slowly, depends on food in stomach, pH of gastric content. Liquid
absorbs more quickly than extended release
- Sublingual: Absorbed more quickly, placed under the tongue. Mucosa under tongue
is very vascular. Do not eat or drink until medication is completely absorbed.
- Inhalation: Absorption happens very quickly.
- Intradermal/topical: Absorption is slower. Lidocaine patch: slow steady release.
- Subcutaneous/intramuscular: Absorption depends on the solubility of the medication
and the blood perfusion at site
- IV: absorption happens immediately
Distribution: After absorption. Medication travels to the site of action. Medications need binding
proteins in order to be distributed to travel to site. Albumin is a common protein used to bind, if
pt.’s levels are low, will impact medication distribution.
Metabolism: Medication is inactivated or broken down into a less active form by enzymes. Most
happens in the liver. Bowel, lungs, and kidneys can also be involved.
- Infants have immature metabolism which increases risk for toxicity. Older adults
have problems with liver and kidneys which slow down metabolism, leads to higher
risk of toxicity
- First Pass Effect: Oral medications inactivated through first pass through the liver.
May need to give a higher dose for therapeutic effect to be felt
- Excretion: Primarily happens in the kidneys. If not working higher risk for toxicity
Minimum Effective Concentration and Therapeutic Index: Dosing- want to receive a medication
level that is above MEC and but be below level of toxicity. Some medications have a high
therapeutic index and some a low therapeutic index (vancomycin). To do this you take blood
samples of the medication’s trough levels and peak levels.
, 2
Medication Half-life: The time the medication is reduced to 50%. Short half-life: eliminated
quickly. Long half-life: lingers in body and has increased risk of toxicity.
Agonist vs. Antagonist:
Agonist: medication designed to produce an action (morphine: bind to receptors and produce an
action)
Antagonist: medication designed to block an action (naloxone: bind to receptors to block action)
Routes of Administration:
- Oral: May need to mix with a little apple sauce or pudding to help with swallowing.
Patient should sit up right, help with swallowing: tuck chin into chest when swallowing.
Should never crush or chew enteric coated or extended release capsules
- Sublingual: Under the tongue. Do not eat or drink until completely absorbed
- Transdermal: Important to wash the skin with soap and water and dry before putting
patch. Remove old patch before putting new one on, rotate sites to prevent irritation.
Choose hairless area of skin.
- Eye medications: Surgical aseptic technique. Drops: place in the center of the
conjunctival sac. After that put gentle pressure on the nasolacrimal duct for 30-
60 seconds. Never touch bottle to eye
- Ear drops: Place on unaffected sites. Adults: back and up. Children: back and down.
- G tube or NG tube: Flush the tube before and after each medication with 15-30mL
of sterile water. Flush at the end with the same
- Suppositories: Place the patient on left side, place in anus just past the external sphincter
and keep it inside of them for at least 5 minutes
- Inhalation: Metered dose inhaler: shake at least 5-6 times, breathe out, push inhaler,
breathe in 4-5 seconds, then hold breath for 10 seconds before exhaling. Dry powder:
Don’t shake, deep breath, hold
- IM injections: Under 2 years old use vastus lateralis muscle (IMPORTANT). After that
you can also use the ventrogluteal site, dorsal gluteal site or deltoid. Solution volume: 1-
3ml
- Intradermal injections: Low volumes of solutions, no more than 0.1ml, hold needle at a 5-
15 degree angle with bevel up
- Subcutaneous: needle 3/8 to 5/8 inch, 25- or 27-gauge needle and inject at a 45 or 90
degrees if obese.
- Intramuscular injection: needle length 1 to 1 ½ inches, 22 to 25-gauge needle with 90
degree angle. Some use a Z track injection: pull skin, inject needle, remove needle, let go
of skin.
- IV: 20 gauge catheter is standard (fluids, and blood can be given through them),
trauma patients need something bigger (16 gauge catheter). Child and older adults: 22
or 24 gauge catheter. Epidural: between 4th and 5th vertebrae.
Chapter Two: Safe Medication Administration and Error Reduction
, 3
Safe Medication
Administration Prescriptions:
- Routine order/standard prescription: for medications patient needs to take ongoing. As
the nurse, you can give medication 30 minutes before or after the time the medication is
prescribed.
- One time/single prescription: Medication is only given once and is not ongoing
- STAT prescription: Medication that the nurse needs to given right away for an emergency
- PRN prescriptions: As needed, needs to be dose, frequency and what condition
the medication should be given
- Standing prescription: written for specific circumstances on specific units
Components of an Order (IMPORTANT)
Patients name, date and time of prescription, the name of the medication, the dose, the route, the
time and frequency of the medication, and physicians’ signature
Telephone orders: Have second nurse in on the call and read back what you heard the doctor
say, make sure all components are there. Sign off within 24 hours
Medication reconciliation: Gather information about what meds are taken at home. Done at
admission, when transferred to another unit, and at discharge.
Rights of Medication Administration:
- Right patient: correct patient identifiers (name, DOB, medical record number) NOT room
- Right medication
- Right dose
- Right time
- Right route
- Right documentation
- Patients RIGHT to
refusal Written prescriptions:
ISMP: list of abbreviations NOT to use.
Key:
- IU: international units
- U: units
- QOD/QD: every other day, every day
- SC/SQ: subcutaneous injection
Writing dose: “be a leader not a follower” 0.5 = yes .50 = no
Never administer medication someone else has prepared.
