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Pharmacology ATI Exam
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Pharmacology ATI Exam
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Pharmacology ATI
Exam Chapter 1: Pharmacokinetics and Routes of
Administration
• Absorption – how quickly or how well it is absorbed; DEPENDS ON THE ROUTE
o Oral – takes a while, must pass through the GI tract
▪ Food can SLOW this down
▪ pH juices play a role
▪ Liquids vs extended release tablets
o Sublingual – quick, under the tongue
o Intradermal/topical – slow, gradual
o Intravenous (IV) – the FASTEST route; immediate absorption
• Distribution – requires binding proteins of medication
o Albumin is a common binding protein
• Metabolism – medication is inactivated
o Occurs primarily in the LIVER
o Factors that Influence Metabolism:
▪ Age – dysfunction of liver
▪ Children – metabolism is not mature yet
o First-pass effect – medications are inactivated through their first pass of the
liver; THEREFORE, you may need a HIGHER DOSE of the medication to reach
therapeutic effects
• Excretion – primarily done by the KIDNEYS
• Therapeutic Index
o HIGH TI = wide safety margin, no need for routine monitoring
o LOW TI = small safety margin; NEEDS MONITORING; HIGH risk of toxicity
▪ Ex: vancomycin; need to draw peak/trough blood levels
• Half-life – the amount of time it takes for the medication in the body to drop by 50%
o Short half-life – leaves the body quickly
o Long half-life – lingers in the body for long periods; HIGH risk of toxicity
• Agonist – medication designed to produce an action
• Antagonist – opposes the action
• Nursing Considerations for Routes of Administration
o Oral:
▪ May need to mix with apple sauce
▪ Want patient to sit up/Fowler’s position
▪ “Chin to chest” to help with swallowing
▪ REMEMBER! NEVER chew enteric-coated capsules
▪ REMEMBER! Never break/chew extended-release capsules
o Sublingual/buccal:
▪ Keep medication in place until it is completely dissolved
▪ DO NOT eat/drink until it is completely dissolved
o Transdermal:
▪ Wash and dry thoroughly
▪ Place patch on a hairless area
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▪ Rotate patch sites
o Eyes:
▪ Put into conjunctival sac
▪ Apply pressure to the nasolacrimal duct
▪ Wait 5 minutes between different drops
▪ Never touch the eye with the dropper (1-2 cm away)
o Ears:
▪ Lay on unaffected side
▪ Pull up and out if they are an ADULT
▪ Pull down and back if they are a CHILD
o NG/Nose:
▪ Flush before and after with 15 ml
▪ One last flush of 15 ml-30 ml
o Suppository:
▪ Place just beyond the external sphincter
▪ Left lateral sims’ position
o Inhalation:
▪ MDI (meter dose inhaler)
• SHAKE 5-6 TIMES
• TAKE DEEP BREATH 3-5 secs
• HOLD BREATH 10 secs
▪ DPI (dry powder inhaler)
• AVOID SHAKING INHALER
• HOLD BREATH 10 secs
o Intramuscular:
▪ REMEMBER! VASTUS LATERALIS for children under 2 years-old
▪ REMEMBER! DELTOID site MAX 1 mL of fluid
▪ REMEMBER! Z-TRACK prevents medication from walking back
into subcutaneous tissue
Chapter 2: Safe Medication Administration and Error Reduction
• Routine/standard – regular schedule medication
• One-time – only one dose
• STAT – immediately
• PRN – as needed
• Medication reconciliation – comparing at home medications with hospital medications
o Done UPON ADMISSION
o Done UPON TRANSFER
o Done AT DISCHARGE
• REMEMBER! NEVER use trailing 0
• REMEMBER! ALWAYS use leading 0
• REMEMBER! NEVER administer a medication prepared by someone else
• REMEMBER! NEED to fill out INCIDENT REPORT if given the WRONG MEDICATION
o INCIDENT REPORTS DO NOT GO IN THE PATIENT’S CHART
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Chapter 4: Intravenous (IV) Therapy
• Risks Associated with IV Therapy
o Circulatory overload if the dose is too large or too rapid
o Little time to correct errors
o Failure to maintain surgical asepsis
• DOs and DON’Ts
o REMEMBER! NEVER put IV meds through tubing that is infusing blood or
blood products
o REMEMBER! NEVER infuse meds through tubing that is administering TPN
o Verify compatibility of medications
o Use a BP cuff instead of tourniquet; especially for OLDER ADULTS
o Hold arm below the level of the heart
o Try to stay away from back of hand
o Want to change sites (usually every 72 hours)
o REMEMBER! Fluids should NOT hand for more than 24 hours UNLESS it is
a CLOSED BAG SYSTEM
o Start distally 1st
o Flush IV every 8-12 hours to keep patency
o Monitor every hour at the least
• Complications
a. Infiltration – solution outside of the veins
i. PALLOR, SWELLING, COLDNESS
b. Extraversion – medication leaking outside of the veins
i. PAIN, BURNING, REDNESS, SWELLING
c. Hematoma – bruising at the site
d. Catheter embolus (VERY SERIOUS SITUATION) – missing catheter tip
after discontinuation
e. Phlebitis –
i. EDEMA, WARMTH, BURNING, PAIN
f. Cellulitis –
i. PAIN, WARMTH, EDEMA
ii. SYSTEMIC SYMPTOMS: MALAISE, FEVER
g. Fluid overload –
i. DISTENDED NECK VEINS, HYPERTENSION, TACHYCARDIA,
CRACKLES, DYSPNEA
Chapter 6: Individual Considerations of Medication Administration
• Factors Affecting Medication Dosages and Responses
o Body weight – the bigger someone is, the higher the dose will need to be to get
therapeutic effects
o Age – Young children will need a smaller dose because their liver/kidneys are not
fully developed, blood-brain barrier poorly developed, increased ability to
absorb topical medications; older client’s liver/kidney function may be impaired
o Gender – females have a higher proportion of body fat
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