ATI Pharmacology Study Guide (notes/summary) complete, A+ Guide
Pharmacology for Nursing Video 1(Introduction, General tips):
• SKIP Chapter 5 and Chapter 3 (drug math)
1. You NEED to know the generic names of all drugs…brand names will not always be on test
2. “common side effects” go with Headaches or GI upset not anything serious like bleeding.
3. Know side effects of prednisone (steroid): weight gain, fluid retention, hypoglycemia, bone
less etc.
4. Herbs that start with the letter “G” (garlic, ginger) all can increase risk of BLEEDING.
5. Medications that end in MAB or NIB are typically immune suppressants that are used to treat
cancers or autoimmune disorders…big thing to watch out for is INFECTION.
6. Patients should never discontinue their medications suddenly
Never double up on doses if you miss a dose
7. Antibiotics: entire course of therapy should be taken and culture should be done before
starting
8. Alcohol is not okay with most meds.
9. You cannot chew or crush extensive release drugs.
Video 2 and 3: Pharmacokinetics:
1. Absorption, Distribution, Metabolism, and Excretion (absorption is dependent on route;
is there food in their stomach?; etc.)
1. Inhalation and sublingual are very fast. IV is immediate.
1. Digestion: albumin is needed for binding.
2. Metabolism: higher risk of toxicity in infants because their livers are not mature.
Metabolism will be slower in older adults which will also lead to toxicity.
2. First pass effect of liver-Higher dose is needed on first dose to get a therapeutic effect.
3. Certain medications have a high therapeutic index meaning toxic level and therapeutic
index are far off. Low TI level means its very close to toxic range.
4. Half life: time it takes for the strength of the medication to be cut in half. Longer half
life=increase risk of toxicity.
5. Agonist: is used to enable an action.
6. Antagonist: like naloxone, is used to reverse that action.
7. Mix meds with applesauce so they can finish the whole thing and get all their meds.
8. Advice patients to sit upright.
9. PATCHES (transdermal): wash skin with soap and water, dry thoroughly, remove old patch
before putting new patch, rotate patches, and choose a hairless area to apply patch.
10. For meds in EYES, pull down conjunctiva and put one drop in aseptically.
11. For meds in EARS, have them lie on unaffected side, put drop, and move auricle.
12. Meds through GI TUBE..flush with 15ml with sterile water both before and after.
13. Meds through SUPPOSITORY. Lay on their side. Push meds past external sphincter for
20-30 minutes and 60 minutes for systemic absorption.
14. INHALER (MDI/DPI inhaler) Shake inhaler 5-6 times, Press inhaler and take a deep breath,
hold breath for 10 seconds before exhaling.
15. IM injections…for under 2years old, you're going to use vastus lateralis. After 2, use ventral
gluteal site or deltoid site. Vastus and gluteal can accommodate 2ml of fluid. Deltoid can take
only 1ml. Need a needle length 1-1.5 inches long—>inject at a 90 degree angle.
16. SubQ: 45 degrees to 90 degrees.
17. IV: 20 gauge are standard. Surgery: 18 gauge. Child or Older adult: 22-24 gauge.
Video 4 (Chapter 2 in book):
1. PRN prescriptions are for “as needed” (like Zofran for nausea and vomiting)
2. Patient name, date and time of prescription, route, frequency/time, and name of prescription.
3. Always do a READ BACK for accuracy. Phone prescriptions need to be signed within 24
hours.
,4. 6 Rights of Medications:
1. Right patient
2. Two patient identifiers (name and date of birth) (NOT their room).
3. Right medications
4. Right dose
5. Right route
6. Right documentation.
(Patients also have a right to refuse medications)
5. Prescription abbreviations that should not be used IU(international units) QD (every other
day); SC or SQ for SUBQ.
6. Always need a leading zero. (instead of .5 it should be 0.5)
7. Need to document everything.
Video 5 (Chapter 3):
1. Always make sure to ROUND if they ask for it or your answer will be wrong.
Video 6 (Chapter 4) IVs:
• IV medications are absorbed right away
• Risks associated with IVs…(heart failure: run the risk of circulatory overload) (adminstering
the wrong meds) (vancomycin: irritates the veins)
• Failure to use aseptic technique..leads to sepsis.
• Patients are given IV fluid/bolus(large volume over short period of time)
• DONT:
• Never put into tubing that are tubing blood
• use the back of their hand
• fluids should not hang for long periods of time (replace tubing and fluid bag every 24 hours)
• DO:
• verify compatibility of the meds you are infusing
• hold their hand below the level of the heart
• change IV sites every 72 hours
• wipe all ports with alcohol before infusing anything.
Gauge size:
• 16 gauge should be used for trauma
• 18 for surgeries
• 20 is default (can use 22 or 24 for older patients or children)
• Document catheter size, site, and date and time of insertion.
Veins:
• Start with distal
• flush IV every 8-12 hours
• monitor site and infusion rate every hour.
Infiltration:
• S/S: pallor, local swelling and decreased skin temperature around site.
• stop the infusion, remove the catheter, elevate extremity, and cold/hot compress.
Hematoma:
S/S: bruising at site. Warm compress and elevate extremity.
Catheter embolus: DANGEROUS!
• Missing catheter tip, can travel to lungs
• Place a trinket high up on the extremity, prepare patient for X-ray and surgery.
Phlebitis:
• S/S increased skin temperature, will feel hard.
• Stop the IV, remove the catheter, apply a warm compress, elevate the extremity.
Cellulitis:
S/S: systemic fever, malaise
antibiotics, analgesics, pyretics, cold compresses.
Fluid overload:
• Crackles in the lungs, edema, distended neck veins, shortness of breath
, • slow IV rate, put up the bed, and give diuretics.
Video 7 MEDICATION DOSING:
• Size: The bigger someone is the more meds they will need
• Age is another factor (children’s metabolism is impaired) Same thing with older clients
because their liver and kidney functions might be impaired, impairing their metabolism.
• Sex: Females have a higher proportion of body fat, so we respond differently.
• Tolerance: IV drug users….wont touch them if you try to give them little meds.
• Accumulation: A patient with decreased renal function, not excreting properly, can lead to
toxicity.
• Psychological factors: Placebo effect, positivity and negatively can impact their response to
the medications.
• Inadequate gastric acid, can effect their absorption.
• Vascular insufficiency: medications wont circulate.
• Liver disease and kidney disease: impairs metabolism and excretion
• Pediatric dosing: body weight or body surface area
• Older adults have increased gastric PH, less effective in absorption. Insufficient albumin,
Impaired memory. Poly-pharmacy=can lead to toxicity. Use clear and concise instructions
VERBALLY AND IN WRITING. Set up a daily calendar. Organized pill containers.
• Pregnant: most medications should be considered harmful to fetus. Always talk to doctor.
Avoid live vaccines. Should get annual flu vaccine.
Video 8 (CHAPTER 7) ANXIETY DRUGS:
• BENZO, ends in PAM.
• Chlordiazepoxide KNOW: the only one that doesn't end in “pam”
• Uses: seizures, muscle spasms, alcohol withdrawal, maintain anesthesia.
• Works by increasing GABA in the body—>decreases the activity of neurons.
• Side effects: Sedation, respiratory depression, amnesia, dependency, withdrawal.
• for SHORT TERM USE only.
• NEVER stop abruptly
• antidote is FLUMAZENIL**
ATYPICAL: BUSPIRON
• Can be used LONG TERM. Dependency is not likely.
• does not cause sedation
• Takes a few weeks for medication to start work.
• can take with meals to avoid GI upset
• Side effects: dizziness, nausea, headache.
“Women named Pam who has a lot of anxiety, takes a benzo, realizes benzo is not for long term
so she takes a BUS to a Pier and decides she's going to wean benzo and take buspiron.”
SSRI: end in “ENE” Fluoxetine:
• Anxiety, depression, OCD, and PTSD
• Inhibits serotonin re-uptake.
• “Teens can sometimes be difficult and sometimes cause anxiety and depression in parents”
• Side effects: Insomnia (peroxitine), nausea, fatigue, weight gain, sexual side effects
• Watch out for symptoms of serotonin syndrome: Agitation, hallucinations, fever, diaphoresis.
• Full effects are not felt for up to a month. Not immediate.
Video 9 (MEDICATIONS TO TREAT DEPRESSION):
SSRI: end in “ENE” Fluoxetine:
• Anxiety, depression, OCD, and PTSD
• Inhibits serotonin re-uptake.
