Pharmacology Proctored ATI Study Guide, Summer 2022

macology 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