Pharm ATI Study Guide

Pharm ATI Study Guide Pharm ATI Study Guide  GENERAL TIPS o -sone = steroids- weight gain, fluid retention hyperglycemia hypokalemia peptic ulcer disease o herbal supplements- if start with “G”- increase risk of bleeding o mab or nib= immunosuppressants, cancers, auto immune- risk of infection o Most meds contraindicated for pregnancy o Patients should never stop med abruptly and if miss dose, do not double up unless birth control o Complete entire course of antibiotic therapy and do culture BEFORE begin antibiotic o Never chew or crush ER capsules/tabs o Don’t drink alcohol  CHAPTER 1- o ROUTES OF ADMIN  Absorption  Depends on route o Oral- takes a while b/c goes through GI tract  pH, food in stomach, liquid or capsule impacts  may need to mix med with applesauce if unable to swallow  sit upright or put chin into chest to aid in swallowing o Sublingual- under tongue, highly vascular; absorbed quickly  Make sure fully absorbed before eat or drink o Inhalation- quickly absorbed- travels to alveoli  Metered dose inhaler- shake inhaler and press inhaler, inhale for 3-5 seconds then hold for 10 seconds before exhale  Dry powder- do NOT shake device, take deep breath and hold for 5-10 seconds o Transdermal/topical- slow and gradual  Wash skin with soap and water before apply patch and remove previous patch before new  Choose hairless skin if possible  Rotate patch sites o Subcut/IM- depends on solubility of medication and perfusion at site of injection  Subcut- needle length 3/8 -5/8 “ and 25-27 G ; inject at 45-90 degrees  IM- child under 2 – use vastus lateralis (2mL)  If older than 2- deltoid (1 mL max) or gluteal site (2mL)  Needle 1-1 ½ “ long and 22-25 G and inject at 90 angle  Ztrack- iron- pull skin with side of hand then release skin  Intradermal- low volume solution, under 0.1 mLhold needle at 5-15 angle with bevel up o IV- immediately into blood stream  20 G – standard  trauma patient- 16G  surgery patient 18G  Child or someone older -22-24G if don’t need blood o NG tube  Flush tubing before and after each med with 15 mL of water  Distribution  Travels to site of action  Requires binding proteins (albumin)  Metabolism  Inactivated or broken down by enzyme- mostly in liver but also kidneys  Higher risk of toxicity with infants b/c not developed fully  First pass effect- oral meds are inactivated through first pass through liver o May need to give patient higher dose of med for therapeutic effect to be felt  Excretion  Happens through kidneys  If problem with kidneys, then increases risk of toxicity o Therapeutic Index  Range between minimum effective concentration and toxic concentration  Low TI = higher risk of toxicity  Can have high TI or low TI o Low- vancomycin- need blood draws to check trough and peak level to ensure not in toxic range  Half life  Time needed for medication t