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.
Pharmacology Proctored ATI Study Guide
, • 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
Pharmacology Proctored ATI Study Guide
, 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
Pharmacology Proctored ATI Study Guide
, 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.
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.
Pharmacology Proctored ATI Study Guide
, • 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
Pharmacology Proctored ATI Study Guide
, 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
Pharmacology Proctored ATI Study Guide
, 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.
Pharmacology Proctored ATI Study Guide
