ATI Pharmacology Study Guide(Etsy) PDF

Preview

Summary

pharmacology study guide...

Description

Pharmacology Proctored ATI Study Guide Chapter 1: Pharmacokinetics and Routes of Administration • Absorption (depends on route) § 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) § Sit upright or put your chin to your chest to aid in swallowing o Sublingual/buccal § Quick absorption systemically through highly vascular mucous membranes § Must make sure it is fully absorbed before you eat or drink o Inhalation via mouth/nose § Rapid absorption through alveolar capillary networks § Metered-dose inhaler: shake and press, inhale for 3-5 seconds and then hold for 10 seconds before exhaling § Dry powder: DO NOT SHAKE 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 § 20 gauge – standard • 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; higher risk of toxicity 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/produces an action Antagonist: blocks the action 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 1530ml of warm sterile water. o Suppositories: § Left lateral sims position. § 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.

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. 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 § Symptoms - edema, throbbing, paining, burning, increased skin temp

DC infusion and remove catheter, elevate extremity, cold compress to minimize flow of blood and then warm compress to increase circulation o Cellulitis o Fluid overload §

STOP - Practice Question!

A nurse is caring for a client who is taking tamoxifen (Nolvadex) for treatment of breast cancer. The nurse should inform the client that which of the side effects can develop:(Select all that apply) 1) Bradycardia 2) Menstrual irregularities 3) Petechia 4) Hot flashes 5) Vaginal discharge

Ans: 2, 4, & 5

Chapter 6: Individual Considerations of Medication Administration • Pediatric doses based on weight or body surface area • Most medications are potentially harmful to the fetus • Pregnancy is a contraindication for live-virus vaccine • Pregnant women should get the inactivated flu vaccination Chapter 7: Anxiety and trauma- and stressor-related disorders • Benzodiazepines o Chlordiazepoxide, alprazolam § Decrease activity of neurons by enhancing inhibitory effects of GABA § Therapeutic use è seizures, muscle spasm, alcohol withdrawal, induction of anesthesia § Complications: CNS depression (sedation, severe resp depression), amnesia, withdrawal effects (addictive) § ADMINISTER FLUMAZEMIL for benzo overdose (reversal) § Contraindications: short term use for risk of dependency § Nursing admin: keep in a secure place due to dependency risk

•

•

Atypical anxiolytic/ nonbarbiturate anxiolytic o Buspirone § Can take long term § Takes 1 week to take effect and 2-6 weeks for full effect § Taken on a scheduled basis § Therapeutic use è panic disorder, OCD, PTSD § Complications: dizziness, nausea, headache § Can take with food SSRIs o Sertraline, Paroxetine § Increases serotonin in system § Can take 4 weeks to produce therapeutic medication levels § Therapeutic use: insomnia (paroxetine only), OCD, Trauma, Depressive disorders § Complications: sexual dysfunction, weight gain, serotonin syndrome * agitation, hallucinations, tremors, fever, diaphoresis § Nursing admin: can take up to 4 weeks to have therapeutic effects

STOP - Practice Question!

A nurse is caring for an older adult client who is hospitalized. Which of the following medication is likely to put the client at risk for orthostatic hypotension. (Select all that apply): 1) Furosemide (Lasix) 2) Telmisartan (Micardis) 3) Phenelzine sulfate (Nardil) 4) Clopidogrel (Plavix) 5) Atorvastatin (Lipitor)

Correct answer: 1, 2, & 3

Chapter 8: Depressive Disorders (repeat basically) • SSRIs o Fluoxetine § Increases serotonin in system § Can take 4 weeks to produce therapeutic medication levels § Therapeutic use è insomnia (paroxetine only), OCD, Trauma, Depressive disorders § Complications: sexual dysfunction, weight gain, serotonin syndrome (agitation, hallucinations, tremors, fever, diaphoresis), inability to sleep § Nursing admin: can take up to 4 weeks to have therapeutic effects, taper dose due to possible dependence • Atypical Antidepressants o Bupropion § Ther use: Depression, aid for smoking cessation § Complications: GI distress, insomnia, nausea, vomiting, wt. loss, seizures •

Other atypical antidepressants o Trazodone – sedation is a potential problem*

•

Tricyclic Antidepressants o Amitriptyline § Therapeutic use: Depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia § Complications: anticholinergic effects (can’t pee, can’t see, can’t spit, can’t shit), tachycardia, sedation, decreased seizure threshold, excessive sweating, orthostatic hypotension, cardiac toxicity (dysrhythmias, mental confusion, agitation, seizures, coma, death) § Nursing admin: chew sugarless gum, wear sunglasses, eat high fiber foods, increase fluid intake MAOIs o Phenelzine § Therapeutic use: Depression § Complications: CNS stimulations (agitation, anxiety), hypotension, hypertensive crisis § Interactions: most meds, tyramine-rich foods can lead to hypertensive crisis (aged cheese, salami, avocado, pepperoni, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, red wine, some beers) § Client Education: avoid taking any other medications (script or OTC) unless approved by the provider, avoid tyramine rich foods, dietary and med restrictions should be continued for 2 weeks after MAOI has been discontinued, avoid caffeinated beverages/chocolate/fava

•

beans/ginseng, do not use within 10-14 days before or after surgery, can take 1-3 weeks to begin experiencing effects and full effects can take 2-3 months, sudden discontinuation can result in relapse, therapy is usually continued for 6 months to a year after symptoms have resolved, assess for suicide

STOP – Practice Question! A nurse is caring for several patients who have bipolar disorder. The nurse should recognize that which of the following medications are appropriate for treating this condition (Select all that apply): 1) paraoxetine (Paxil) 2) lithium (Lethane) 3) tranylcypromine (Parnate) 4) valproic acid (Depakote) 5) phenytoin (Dilantin) 6) carbamazepine (tegretol)

Correct answers: 1, 2, 4, & 6

Chapter 9: Bipolar Disorders •

•

Mood Stabilizer o Lithium Carbonate § Complications: GI distress, fine hand tremors (expected), polyuria, wt. gain, renal toxicity, electrolyte imbalances, Lithium toxicity (confusion, COURSE TREMORS, tinnitus, hypotension, coma and possibly death). § Toxic levels >1.5 § Interactions: Diuretics DO NOT TAKE (decreases amount of sodium and thus likelihood of toxicity), NSAIDs (will increase renal absorption and lead to toxicity), anticholinergics Mood stabilizing antiepileptic drugs o Carbamazepine, Valproic Acid § Complications: blood dyscrasias!* (leukopenia, anemia, thrombocytopenia- monitor CBC), double vision, nystagmus, hypoosmolality (monitor serum sodium) § Complications (valproic acid): GI effects, hepatotoxicity, pancreatitis, thrombocytopenia

STOP – Tips! à à à à à

Herbal supplements that start with a ‘G’ = increase the risk for bleeding -mab or -nib = immunosuppressants Patients should never stop a medication abruptly; if they miss a dose, they should not double up (UNLESS IT IS BIRTH CONTROL) Complete the entire course of antibiotics; a blood culture must be done PRIOR to beginning antibiotic therapy -sone = steroids; weight gain, fluid retention, hyperglycemia, hypokalemia, peptic ulcer disease

Chapter 10: Psychotic Disorders • Meds are used to treat positive symptoms • Know positive vs negative symptoms • Antipsychotics First generation (conventional) o Haloperidol/Chlorpromazine (low potency) § Complications: Extrapyramidal symptoms (acute dystonia – severe spasms of tongue, neck, face, or back, parkinsonism, akathisiainability to stand or sit still, Tardive dyskinesia (TD) – involuntary movements of tongue and face such as lip-smacking). Neuroleptic Malignant Syndrome – high grade fever, muscle rigidity, dysrhythmias. § Nursing administration: administer anticholinergics, beta-blockers, and benzos to control EPSs. Advise clients can take 2-4 weeks for significant improvement. § Consider Depot preps which are administer IM once every 3-4 weeks for people who have trouble maintaining a regimen. • Antipsychotics: 2nd and 3rd generation (atypical) o Risperidone/Clozapine § Controls positive and negative symptoms. § Complications: DM, Wt. gain, Hypercholesterolemia, Orthostatic hypotension, anticholinergic effects. § Nursing admin: administered IM once every 2 weeks (Risperidone)

Chapter 11: Meds for children and adolescents who have mental health issues • CNS Stimulants o Methylphenidate/Amphetamine Mixture § ADHD/conduct disorder § Complications: Insomnia, administer last dose before 4pm, decreased appetite, wt. loss

§

Nursing admin: admin during or immediately after meals, monitor clients weight.

STOP – A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? A. The medication should be taken 1 hr prior to eating B. It takes 48 hr for therapeutic effects to occur. C. Tablets should not be crushed or chewed. D. Decreased respirations might occur. Correct answer: D A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer? A. Methadone B. Naloxone C. Diazepam D. Bupropion Correct answer: B A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? A. Carbamazepine B. Sumatriptan C. Atenolol D. Glipizide Correct answer: A

Chapter 12: Substance Use Disorders • Meds to support withdrawal/abstinence from alcohol. o Effects of withdrawal usually start within 4-12 hours of last intake of alcohol and can last 5-7 days: nausea, vomiting, tremors, increased HR/BP/RR, seizures o Withdrawal meds:

Benzos (also used for cocaine toxicity in some cases) • Chlordiazepoxide/diazepam/lorazepam o Decrease risk of seizures, maintenance of vital signs WNL § Adjunct meds with benzos • Clonidine/propranolol/carbamazepine o Decrease seizures (carbamazepine) o Decrease HR and BP (propranolol/clonidine) o Nursing admin: seizure precautions o Abstinence maintenance § Disulfiram • If the patient does consume alcohol, nasty side effects including nausea, vomiting, weakness, sweating, palpitations and hypotension § Naltrexone • Suppresses craving and pleasurable effects of alcohol. • Suggest monthly IM injections for clients who have trouble adhering to oral form. Meds to support withdrawal/abstinence from opioids o Methadone substitution § Dependence will be transferred from illegal to methadone § Methadone must be slowly tapered Meds to support withdrawal/abstinence from nicotine o Bupropion § decreases cravings and withdrawal symptoms. o Nicotine Replacement therapy § Nicotine gum/patch/nasal spray o Varenicline § Reduces cravings for nicotine as well as the severity of withdrawal symptoms. Notify provider if suicidal thoughts or new onset depression occur §

•

•

STOP - Practice Question!

A nurse administers naloxone (Narcan) as prescribed for a client who is 8 hr. postoperative adverse effects after administration of opioid analgesia. Which of the following interventions should the nurse plan to take following naloxone administration? (Select all that apply) 1) Observes the client for bleeding 2) Assess the client for nausea and vomiting 3) Check the client's pain level frequency

4) Monitor the client for bradycardia 5) Repeat the dose every 15 min until the client responds Correct answers: 1 & 2

Chapter 13: Chronic Neurologic Disorders • Cholinesterase Inhibitors o Neostigmine/Edrophonium § Ther use è reversal of nondepolarizing neuromuscular blocking agents, myasthenia gravis § Complications: Cholinergic Crisis (excessive muscarinic stimulation and resp depression), increased GI motility/secretions, diaphoresis, increased salivation, bradycardia, and urinary urgency § Antidote: Atropine • Anti-Parkinson’s agents o Levodopa/carbidopa § Ther Use: Parkinson’s § Adverse effects: nausea/vomiting/drowsiness, dyskinesias (tics), orthostatic hypotension, psychosis, discoloration of sweat and urine (harmless) § Education: eat less protein, increase carbs • Anti-epileptics o Phenytoin/Carbamazepine/Valproic acid/lamotrigine § Phenytoin: • Adverse effects: nystagmus, sedation, ataxia, double vision, gingival hyperplasia, skin rash, dysrhythmias, hypotension, coarsening of facial features, hirsutism, interference with Vit D metabolism, interference with Vitamin K dependent clotting factors causing bleeding in newborns • Education: Can cause decreased effects of oral contraceptive and monitor therapeutic levels. § Carbamazepine • Complications: Nystagmus, double vision, vertigo, staggering gait, h/a, cognitive function minimally impaired, leukopenia, anemia, thrombocytopenia, FVO for pt. with Heart failure (promotes excretion of ADH), dermatitis, rash, Steven-Johnson syndrome

Chapter 14: Eye and Ear Disorders • Types of Glaucoma

•

•

• •

o Primary Open-angle glaucoma (POAG) – most common, peripheral vision lost gradually o Angle-closure (narrow-angle) glaucoma – acute disorder resulting in irreversible blindness – treated with mannitol Beta-adrenergic blocker o Timolol § Complications: stinging discomfort, systemic effects of beta blockers on heart and lungs – overdose can increase chances of these effects § Nursing admin: instill one drop in the affected eye once or twice daily, avoid touching applicator and keep lid in place when not in use, hold gentle pressure to the nasolacrimal duct for 30-60 sec after application to prevent or minimize systemic effects Carbonic anhydrase inhibitor (systemic) o Acetazolamide § Complications: GI side effects (give with food), electrolyte depletion (sodium and potassium), generalized flu-like symptoms Otitis Externa: treated by topical antimicrobial/anti-inflammatory combination Fluoroquinolone antibiotic plus steroid medication o Ciprofloxacin plus hydrocortisone otic drops § Nursing admin: warm by gently rolling the container between hands, gently shake medication, keep client in side-lying position for 5 minutes after instillations, place a piece of cotton in ear and remove after 5 min, dry ear canal after bathing or swimming using a towel and tilting head to promote drainage

Chapter 15: Miscellaneous CNS meds • Neuromuscular blocking agents o Succinylcholine(depolarizing)/Pancuronium(nondepolarizing) § Pharm action: block acetylcholine at the neuromuscular junction § Complications: Resp arrest, Malignant hyperthermia – muscle rigidity accompanie...