HESI PN PHARMACOLOGY PROCTORED EXAM

HESI PN PHARMACOLOGY PROCTORED EXAM

VERSION 6

Chapter 1:

Pharmacokinetics and Routes of Administration  Absorption – how quickly or how well it is absorbed; DEPENDS ON THE ROUTE

• 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

• Sublingual – quick, under the tongue
• Intradermal/topical – slow, gradual
• Intravenous (IV) – the FASTEST route; immediate absorption

 Distribution – requires binding proteins of medication

• Albumin is a common binding protein

 Metabolism – medication is inactivated

• Occurs primarily in the LIVER

o Factors that Influence Metabolism:

 Age – dysfunction of liver  Children – metabolism is not mature yet

• 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

• HIGH TI = wide safety margin, no need for routine monitoring
• 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%

• Short half-life – leaves the body quickly
• 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  Rotate patch sites

o Eyes:

 Put into conjunctival sac 1 / 3

 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

• Done UPON ADMISSION
• Done UPON TRANSFER
• 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 

• INCIDENT REPORTS DO NOT GO IN THE PATIENT’S CHART

Chapter 4: Intravenous (IV) Therapy

 Risks Associated with IV Therapy

• Circulatory overload if the dose is too large or too rapid
• Little time to correct errors
• Failure to maintain surgical asepsis

 DOs and DON’Ts

• REMEMBER! NEVER put IV meds through tubing that is infusing blood or blood

products

• REMEMBER! NEVER infuse meds through tubing that is administering TPN
• Verify compatibility of medications
• Use a BP cuff instead of tourniquet; especially for OLDER ADULTS
• Hold arm below the level of the heart 2 / 3

• Try to stay away from back of hand
• Want to change sites (usually every 72 hours)
• REMEMBER! Fluids should NOT hand for more than 24 hours UNLESS it is a CLOSED BAG

SYSTEM

• Start distally 1

st

• Flush IV every 8-12 hours to keep patency
• Monitor every hour at the least

 Complications

• Infiltration – solution outside of the veins
• PALLOR, SWELLING, COLDNESS
• Extraversion – medication leaking outside of the veins
• PAIN, BURNING, REDNESS, SWELLING
• Hematoma – bruising at the site
• Catheter embolus (VERY SERIOUS SITUATION) – missing catheter tip after

discontinuation

• Phlebitis –
• EDEMA, WARMTH, BURNING, PAIN
• Cellulitis –
• PAIN, WARMTH, EDEMA

ii. SYSTEMIC SYMPTOMS: MALAISE, FEVER

• Fluid overload –
• DISTENDED NECK VEINS, HYPERTENSION, TACHYCARDIA, CRACKLES, DYSPNEA

Chapter 6: Individual Considerations of Medication Administration

 Factors Affecting Medication Dosages and Responses

• Body weight – the bigger someone is, the higher the dose will need to be to get

therapeutic effects

• 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

• Gender – females have a higher proportion of body fat
• Tolerance (IV DRUG USERS)
• Accumulation – if someone has impaired kidney function, they may not be able to

excrete it properly which could lead to toxicity

• Psychological factors – someone’s frame of mind can impact effects
• Medical problems –

 Diarrhea  Inadequate gastric acids  Liver disease  Kidney disease  Pregnant

• REMEMBER! MOST OF THE TIME it is NOT okay to take medications while pregnant
• REMEMBER! Pregnant women should NOT have live vaccines (measles, mumps, rubella,

polio)

• REMEMBER! They should get the INACTIVATED INFLUENZA vaccine

Chapter 7: Anxiety and Trauma-and Stressor-Related Disorders

 Benzodiazepines (end in –am)

• Diazepam
• Lorazepam
• Alprazolam
• Chlrodiazepoxide

 Use: treatment of ANXIETY, seizures, muscle spasms, alcohol withdraw

 Action: increase the effects of GABA in your body

 SE: SEDATION, RESPIRATORY DEPRESSION, amnesia, dependency, withdraw

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