• abosorption
• distribution
• metabolism
• exctretion

plasma medications can be regulated to control medication responses.

Attempts to maintain levels between the minumum effective concentration  and toxic concentration

refers to the period of time needed for medication to be reduced by 50% in body.

Short Half Life:

meds leave in 4-8 hrs

short dosing of MEC will drop between doses

Long Half Life:

meds leave in 24+ hrs

greater risk for toxicity and med accumulation

meds take a longer time to reach a steady state

mechanism of action - describes the interactions between medications and target cells, organs, and body systems

• AGONIST
• ANTAGONIST
  PARTIAL AGONIST

Agonist

Antagnoist

Partial agonists

Agonist - mimics receptor activity ex. morphine sulfate

Antagonist - block normal receptor activity ex. Losartan (Cozaar)

Partial Agonists - agonist or antagonist ex. Nalbuphine (Nubain)

Oral or enteral (tablets,capsules,liquids,suspensions,elixir)

sublingual (under tongue)

Buccal (between cheek)

Transdermal (skin patch)

Topical

Instillation (drops, ointments, sprays, generally used for eyes ears and nose)

Suppositories

Parenteral

Intradermal

Subcutaneous

Intramuscular

Z-Track

Intravenous

Epidural

Inhalation

Nasogastric and Gastrostomy Tubes

• Contraindications- vomitting, no gag reflex, difficult swallowing and decreased LOC
• Fowlers position
• Irritating with small amounts of food
• No grapefruit Juice
• be carefeul of cutting, crushing, and diluting

Sublingual

Buccal

• Keep med in place until absorbed
• do not eat or drink while in place

• apply patches
• wash skin tih soap and water and dry
• hairless area
• rotate sites to prevent skin irritation

• apply with glove, tongue blade, or applicator
• never apply with bare hand

Eyes

surgical aseptic

dropper 1 - 2 cm above in center of sac

close eye gently

gentle pressure on nasolacrimal duct

Ears

medical aseptic

dropper 1 cm

apply pressure to targus of ear

Nose

medical aseptic

breath through mouth

stay in supine position

avoid blowing nose for 5 min

Inhalation

MDI 

shake 5-6 times

2-4 cm away from mouth

while pressing inhaler slow deep breath for 3-5 sec

hold breath for 10 sec

slowly exhale

DPI
Dont shake

exhale completly

deep breath through mouth

hold 5-10 sec

• allow med to flow in by gravity
• use liquid form
• do not give sublingual
• do not crush prepared oral meds
• flush with 5-30 ml before and after with warm water to prevent clogging
• flush with 30-60 ml of water when admin of med complete

• wear gloves
• lubricate suppository
• instruct to leave 20-30 min for simulation of defacation

• steral technique
• vastus lateralis for children under 2
• ventral gluteal for over 2
• both sited can accomodate 2 ml of fluid
• deltoid only 1 ml of fluid
• appropriate needle size and length
• tuberculin syringe for less than 0.5 ml
• do not inject edematous, inflamed, moles, birthmarks,scars
• Discard all sharps

• TB Testing
• small amounts of solution
• inner surface of midforearm or scapular area
• 10-15 degree angle

Z-Track

• IM injection that prevents medication from leaking into subcutaneous tissue
• meds that may cause permanent skin stains

• medications, fluids, blood
• short term use (catheter)
• long term use (Port)
• peripheral veins in hand or arm perferrde for short term

• IV opioid
• insterted in to epidural space and the fourth or fifth vertebrae
• always use infusion pumps to administer medication

QUESTION #1

Place the phases in correct order

• Distribution ____
• Excretion ____
• Absorption ____
• Metabolism ____

1. absorption
2. distribution
3. metabolism
4. excretion

Question #2 - Match

Oral, IM, IV, Inhalation

                     provides immediate response

                          easy to administer

          allows med to be admin at site of action
        allows admin of meds poorly soluable in H2O

oral - easy to admin

IM - allows for admin of meds poorly soluable in h2O

IV - immediate response

Inhalation - site of action

QUESTION #3

A nurse is administering eye drops to a client. Which of the following actions should the nurse take

1. use sterile technique
2. ask client to look up at ceiling
3. place client in side lying position
4. from med into conj. sac at inner canthus
5. instruct client to close the eye gently after application

QUESTION #4

a nurse is preparing to administer medications for a client who is receiving enteral feedings through a gastrostomy tube. Which of the following actions should she take?

1. Crush extended release
2. admin SL tablets under tongue
3. Flush with 10 ml of warm water when completed
4. Add meds to enteral feeding

• chemical name is the name of the med determined by chemical comp
• Generic name is given by United States Names Council - each med only has 1 generic name
• trade name is the brand or proprietary name given by company that manafactures med - meds may have multiple

• potential for abuse and dependance
• medications catergorizes in schedules I-V
• each level has decreasing risk of abuse and dependance

• Routine/Standard Order - meds that are given on a regular schedule. Med is in effect until provider D/C's it
• Single/One Time Order - only given once at a specific time or ASAP
• Stat Order - Given once and given immediately
• PRN Order - nurse uses clinical judgement to determine clients needs
• Standing Orders - written for specific circumstances

1. Right Client
2. Right Medication
3. Right Does
4. Right Time
5. Right Route
6. Right Documentation

QUESTION #1

a nurse is preparing a clients medications. Which are the nurses legal responsibilities

1. evaluating the clients response to med
2. determining the accuracy of the med order
3. choosing the route it should be given
4. storing meds safely
5. deciding the dosage of the med

QUESTION #2 - Match

Contraindications,Toxicity,Mechanism of Action,Therapeutic Effect

1. how the med produces the desired therapeutic effect
2. primary action for which med is prescribed
3. indications for why a med should not be given
4. a serious advers effect usually by excessice dosing

Contraindications - 3

Toxicity - 4

Mechanism of Action - 2

Therapeutic Effect - 1

QUESTION #3

a health care provider prescribes lasix 40mg po now. what kind of order is this

1. single
2. stat
3. routine
4. standing

Question #4

a nurse is preparing to administer a clients morning insulin dosage, which action should be taken first

1. Review clients BG level
2. Verify Identity
3. Ask another nurse to check amount of insulin in syringe
4. wash injection site with soap and water

CHAPTER 3 - Dosage Calculations

Know how to do this

1mg = 1000mcg

1g = 1000 mg

1kg = 1000g

1oz = 30ml

1L = 1000ml

1tsp = 5 ml

1tbsp = 15ml

1 tbsp = 3tsp

1kg = 2.2lb

1gr = 60mg

CHAPTER 4 - Intravenous Therapy

Advantages

fast absoprtion

less discomfort after initial insertion

constant therapeutic blood levels

less irriation to subcutaneous and muscle tissue

Disadvantages

circulatory fluid overload

no time to correct errors

irriation to lining of vein

infection and septicemia

• potassium chloride should never be given iv bolus because of sever adverse effects
• add med to new IV fluid not a bag already hanging
• No Iv Med through a tubing that is infusing blood, or parenteral nutritional
• Verify compatibility

• do not break, bend or recap needles
• older adults taking anticoagulants - avoid tourniquets, use blood pressure cuff, do not slap to see vein
• use standard precautions
• use sterile needle/catheter each attempt
• dont write on IV Bags
• fluids should not hang more than 24 hours

• Find Vein
• cleanse area using circular motion - middle to outward
• tourniquet
• warn clients of "poke"
• insert catheter bevel at 10 -30 degree
• advance catheter - blood return confirms placement
• stablize and release tourniquet
• apply pressure
• apply dressing

• do not allow blood or fluid to back up for any length of time
• make sure dressing is not too tight
• flush ever 8 - 12 hours
• monitor site and infusion rate at least every hour

• clamp IV Tubing
• sterile guaze over site w/o pressure on vein
• withdraw catheter by pulling straight back
• elevate and apply pressure for 2 min

QUESTION #1

a nures is caring for a client with a continous IV infusion, which of the following findings indicate that it has infiltrated

1. damp dressing
2. a decreased rate in infusion
3. palpable, hard mass or band above IV site
4. cool, pale skin surrounding
5. ecchymosis at insertion site

QUESTION #2

A nurse is caring for a pt recieving dextrose 5% in water IV at 100 ml/hr, which may indicate fluid overload

1. decreased blood pressure
2. bradycardia
3. flattened neck veins
4. crackles heard in lungs

QUESTION #3 -

a nurse is preparing to D/C an IV, place correct steps in order

1. elevate and apply pressure for 2 min
2. remove tape and dressing stabilizing IV
3. use nondominant hand to apply sterile guaze w/o putting pressure on vein
4. assess site
5. document
6. don clean gloves
7. use dominant hand to withdraw catheter
8. assess catheter for intactness
9. apply tape over guaze

QUESTION #4

A nurse checks for IV patency of an IV saline lock by

1. assessing the site for redness
2. flushing  the IV with 0.9% sodium cholride
3. asking the client if the site is painful
4. checking the date of insertion

Infiltration - pallor, local swelling, dec skin temp

Phlebitis - edema, throbbing, burning/pain,increased skin temp, red line up arm

Hematoma - Ecchymosis at site

Cellulitis - pain, warmth, red streaking, chills, and malaise

Fluid Overload - Distended neck veins, inc BP, tachycardia, SOB, crackles, edema

Catheter Embolus - missing tip when D/C, sever pain with migration or nonw withough migration

Side Effects - usually expected when a med is given at therapeutic dose

Adverse Effects - undesired, inadvertent, and unexpected dangerous effects of medication

can be either stimulant or depressant

stimulant - clients may be at risk for seizures

depressant - tiredness, do not drive or participate in other dangerous activites

• most common with psychotropic drugs - mental health
• tremors, rigidity, uncontrollable restlessness, acute dystonias
• may occur within hours or take months to develp

• dry mouth
• photophobia (wear sunglasses)
• urinary retention

• orthostatic hypotension - seen with antihypertensive meds
• if low BP is read see what thier baseline has been
• watch pt for falls

• recommend that they take with food
• can cause heart burn
• can cause upset stomach
• Tetracylcine - dont give with milk

• watch for increase bleeding
• bruising is a sign of bleeding
• urine is dark colored
• petechiae - little red bumps
• bleeding gums
• high INR level
• suggest use of electric razor

• labs to check for liver function
• liver is vulnerable since a lot of meds are metabolized through the liver
• can cause problems with metabolizing which than effects toxicity

NSAIDS and anitmicrobial agents result in damage to kidneys

can interfere with excretion therefore toxicity lever increase

aminoglycosides can also cause renal damage

monitor BUN and Creatinin levels

• treat rashed and hives with diphenhydramine (Benadryl)
• treat anaphylactic with epinephrine, bronchodilators, and antihistamines

• depress the immune response and increase risk for infection
• look for fever
• check WBC count
• cant be d/c abruptly mus be tappered

Tyramine while taking MAOI's can lead to hypertensive crisis

VIT K decrease effects of Warfarin (Coumadin) - risk for developing blood clots

Tetracycline - DO NOT TAKE W/DAIRY - do not take within 2 hours of dairy intake

Grapefruit Juice - increases absoprtion of oral meds

Category A - B = no risk

Category C = some risk

Category D = Dr Decision - high risk

Category X - absolutley do not give!

• adverse medication effect that is considered severe
• liver dmage is seen with tylenol overdose
• chronic alcohol use = liver damage
• mucomyst helps minimize liver damage

QUESTION #1

a nurse is obtaining a med history from a client who is to start a new prescription for Coumadin, which of the following OTC should be avoided

1. rantidine
2. docusate sodium
3. acetaminophen
4. asipirin

QUESTION #2

a nurse is ready to administer the first dose of new oral penecillin, the client states she took penecillin 3 yrs ago, and developed a mild rash, what should the nurse do?

QUESTION #3

a nursing responsibility for a client recieving antihypertensive med is to

1. decrease the dose of client experiences tachycardia
2. teach client to change positions slowly to avoid dizziness
3. instruct client to check blood pressure every 8 hours
4. d/c the clients med if BP decreases

QUESTION #4

do drug-drug interactions produce increased or decreased medication effects? Explain