ATI – Pharm- 2020ATI – Pharm- 2020
General Tips
• Know generic names ** – they will always be provided on the test
• Grapefruit Juice good be
... [Show More] t for food interactions
• When asked about common side effect of a medication – Headache or GI upset
• “-sone” ending = steroids – know side effects of steroid medications (weight gain, fluid retention, hyperglycemia, hypokalemia, peptic ulcer disease, bone loss, etc.)
• Herbal supplements that start with “G” = increase r/f bleeding
• End in “-mab or -mib” are typically immunosuppressants used to treat cancers or various immune disorders – big SE is r/f infection
• Most medications are contraindicated for pregnancy
• Never suddenly d/c medications and never double up on doses in general
• AB – complete entire course of therapy and cultures should be taken prior to initiating AB therapy
• Patient should not chew or crush extended release capsules.
• Not advised to take alcohol with most medications
Chapter 1 – Pharmacokinetics & Routes of Administration
• 4 phases of pharmacokinetics
• 1. Absorption – SMALL INTESTINE
Depends on route
Oral – takes a while
• Absorption is also dependent on food on stomach? Ph of gastric contents? Liquid vs. ER capsule?
Sublingual – very quick
• Highly vascular as long as not swallow or eat or drink things
• Wait for it to be completely absorbed
Inhalation – quick
ID or topical – slow or gradual
Subq or IM – depends on solubility and blood perfusion at site
IV – immediate absorption to the bloodstream
• 2. Distribution – CIRCULATION
Meds travel to the site of action
Required binding proteins (albumin)
• 3. Metabolism – LIVER
Med activated or broken down to less active from by enzymes primarily in liver
Metabolism is not very effective as baby – immature organs leads to high r/f toxicity
Older – dysfunction – slows down and is not as effective
First pass effect * – some oral meds are inactivated through the first pass through liver. May need higher dose for therapeutic effect to be felt.
• 4. Excretion – KIDNEYS
BUN & Creat
• Dosing
• Want to maintain plasma levels between minimum effective concentration (MEC) and toxic concentration
• Certain meds may have therapeutic index
Big range between MEC – toxic. Some have a low TI & MEC – toxic is very close and need specific range.
Ex) vancomycin (low TI)
• Therapeutic level and toxic level are very close together, so you have to hit a specific range
• Will have to do blood draws to check TROUGH LEVELS and peak levels to make sure we are not getting into toxic range
• Half-life – period of time needed for a medication to be reduced by 50%
Short half-life – reduced by 50% quick = eliminated out of body quickly
Long half-life – lingering in system for a long time and r/f toxicity goes up
• ** Low TI & long half-life = increased r/f toxicity
• Agonist vs. Antagonist
• Agonist – designed to produce an action
Ex: morphine – opioid agonist
Naloxone – appose an action (antagonist)
• Antagonist – appose an action and block action
• Routes of Administration + Nursing Considerations
• Oral Medication
May need to mix with applesauce to help swallow
Don’t mix with a lot of food because if they don’t finish the food, they are not getting all the medication
Sit upright
Chin to chest to help swallow
Never chew enteric-coated or extended release capsules (just swallow)
• Sublingual Medication
Fully absorbed before patient eats or drinks
• Transdermal Medication
Wash skin with gentle soap or water before patch goes on
Remove old patch before new
Rotate sits to prevent irritation
Hairless area
• Eyes (drops) Medications
Surgical aseptic technique
Drop into center of conjunctiva sac
Gentle pressure for 30-60 seconds at nasolacrimal duct
• Ear (drops) Medications
Lay on unaffected side
Straighten ear canal
• Upward and outward – adults
• Down and back – kids
• NG or G tube Medications [Show Less]