NURSING 101 PHAMACOLOGY PROCTORED ATI STUDY GUIDE PRE-ASSESSEMENT/TEST PREP
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.
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.
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.
Prevention: carefully select site and size of catheter, secure the catheter.
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
o Cellulitis
o Fluid overload
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.
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.
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.
Prevention: carefully select site and size of catheter, secure the catheter.
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
o Cellulitis
o Fluid overload
