ATI (chp 1)

Question 1

pharmacokinetics

Answer 1

Pharmacokinetics refers to how medications travel through the body. Medications undergo a variety
of biochemical processes that result in absorption, distribution, metabolism, and excretion.

Question 2

Absorption

Answer 2

transmission of medications from the location of administration (gastrointestinal [GI]
tract, muscle, skin, or subcutaneous tissue) to the bloodstream.

Question 3

The most common routes of

administration are

Answer 3

enteral (through the GI tract) and parenteral (by injection).

Question 4

The amount of medication absorbed determines…

Answer 4

intensity

Question 5

The route of administration affects…

Answer 5

rate and amount of absorption

Question 6

Oral barriers

Answer 6

Medications must pass through the layer of epithelial

cells that line the GI tract.

Question 7

oral absorption patterns:

Answer 7

Varies greatly due to the following variables:
» Stability and solubility of the medication
» GI pH and emptying time
» Presence of food in the stomach or intestines
» Other medications currently being
administered
» Forms of medications (enteric-coated
pills,liquids)

Question 8

Sublingual/bucca barriers

Answer 8

If swallowed before dissolves then GI fluid might inactivate

Question 9

Sublingual absorption pattern:

Answer 9

Absorbed quickly systemically through highly

vascular mucous membrane

Question 10

Inhallation via mouth or nose absorption pattern:

Answer 10

Rapidly absorbed through alveolar

capillarynetwork

Question 11

Intradermal/topical barriers

Answer 11

epidermal cells are closely packed

Question 12

Intradermal/topical patterns of absorption:

Answer 12

Absorption slow and gradual
› Effects primarily local, but systemic as well,
especially with lipid soluble medications
passing through subcutaneous fatty tissue

Question 13

SubQ and IM barriers

Answer 13

Capillary wall has large spaces between cells; therefore, there is no significant barrier.

Question 14

SubQ and IM absorption patterns:

Answer 14

› Highly soluble medications will be absorbed in 10 to 30 min.
› Poorly soluble medications will be absorbed more slowly.
» Blood perfusion at the site of injection
› Sites with high blood perfusion (e.g., mucous membranes) will have rapidabsorption.
› Sites with low blood perfusion (e.g., skin) will have slow absorption.

Question 15

perfusion

Answer 15

process of a body delivering blood to a capillary bed in its biological tissue.

Question 16

Intravenous barriers

Answer 16

no barriers

Question 17

Intravenous absorption pattern:

Answer 17

Immediate – administered directly into blood

› Complete – all of it reaches the blood

Question 18

Distribution

Answer 18

transportation of medications to sites of action by bodily fluids

Question 19

Distribution can be affected by:

Answer 19

-Travel to the site of action through the bloodstream (Peripheral vascular or cardiac disease may
delay medication distribution.)
-Leave the bloodstream by traveling between the capillaries’ cells
■ Plasma protein binding: Medications compete for protein-binding sites within the bloodstream,
primarily albumin. The ability of a medication to bind to a protein can affect how much of the
medication will leave and travel to target tissues. Two medications can compete for the same
binding sites, resulting in either toxicity or decreased bioavailability.
■ Barriers: Medications that are lipid soluble or have a transport system can cross the blood-brain
barrier or the placenta.

Question 20

Bioavailability

Answer 20

is a subcategory of absorption and is the fraction of an administered dose of unchanged drug that reaches the systemic circulation

Question 21

Metabolism (biotransformation)

Answer 21

changes medications into less active or inactive forms by the action
of enzymes. This occurs primarily in the liver, but it also takes place in the kidneys, lungs, bowel,
andblood.

Question 22

Factors influencing the rate of metabolism of a drug

Answer 22

■ Age – Infants have limited medication-metabolizing capacity. The aging process can also
influence medication metabolism, but it varies by individual. In general, hepatic medication
metabolism tends to decline with age.
■ An increase in certain medication-metabolizing enzymes – This can cause a particular
medication to be metabolized sooner, requiring an increase in dosage of that medication
to maintain a therapeutic level. It can also cause an increase in the metabolism of other
medications that are being used concurrently.
■ First-pass effect – Some oral medications are inactivated on their first pass through the liver
and may require a higher dose to achieve a therapeutic effect, or must be given by a nonenteral
route because of their high first-pass effect. These medications are usually given by alternate
routes such as sublingual or IV.
-Similar metabolic pathways – When two medications are metabolized by the same pathway,
they can interfere with the metabolism of one or both of the medications. In this way,
the rate of metabolism can be decreased for one or both of the medications, leading to
medicationaccumulation.
■ Nutritional status

Question 23

Outcomes of drug metabolism:

Answer 23

■ Increased renal excretion of medication
■ Inactivation of medications
■ Increased therapeutic effect
■ Activation of pro-medications (also called pro-drugs) into active forms
■ Decreased toxicity when active forms of medications are converted to inactive forms
■ Increased toxicity when inactive forms of medications are converted to active forms

Question 24

Excretion

Answer 24

elimination of medications from the body primarily through the kidneys.
Elimination also takes place through the liver, lungs, bowel, and exocrine glands. Renal dysfunction may lead to
an increase in duration and intensity of medication response, so BUN and creatinine levels should
be monitored.

Question 25

MEC

Answer 25

Minimum Effective Concentration

Question 26

plasma medication level

Answer 26

is in the therapeutic range when it is effective and not toxic. Therapeutic levels are well established for many medications, and these levelscan be used to monitor a client’s response.

Question 27

TI

Answer 27

Therapeutic Index
- Medications with a high TI have a wide safety margin. Therefore, there is no need for routine serum medication level monitoring.

Medications with a low TI should have serum medication levels monitored closely.
Monitor peak levels based on the route of administration. For example, an oral medication may have a peak of 1 to 3 hr after administration. If the medication is
given intravenously, the peak time might occur within 10 min. (Refer to a drug reference or pharmacist
for specific medication peak times.)

Question 28

Trough Levels

Answer 28

lowest level drug is present in the blood
-blood is drawn immediately before the next
medication dose regardless of the route of administration.

Question 29

Pharmacodynamics (mechanism of action)

Answer 29

describes the interactions between medications and target cells, body systems, and organs to produce effects.

These interactions result in functional changes that
are considered the mechanism of action of the medication.

Question 30

Agonist Drug

Answer 30

MOA

• mimic the receptor activity regulated by endogenous
  compounds.

For example, morphine sulfate is classified as an agonist because it activates the
receptors that produce analgesia, sedation, constipation, and other effects.

Question 31

Antagonist Drug

Answer 31

MOA
-block normal receptor activity regulated by endogenous
compounds or receptor activity caused by other medications.

For example, losartan (Cozaar),
an angiotensin II receptor blocker, is classified as an antagonist. Losartan works by blocking
angiotensin II receptors on blood vessels, which prevents vasoconstriction.

Question 32

Partial agonists

Answer 32

MOA
-may act as an agonist/antagonist and have limited affinity to receptor sites.

For example, nalbuphine (Nubain) acts as an antagonist at mu receptors and an agonist at kappa receptors, causing analgesia with minimal respiratory depression at low doses.

Question 33

Contraindications for oral administration:

Answer 33

vomiting
absence of gag reflex
difficulty swallowing
decreased level of consciousness

Question 34

Instillation

Answer 34

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

Question 35

MDI

Answer 35

metered dose inhalers [MDI] or dry powder inhalers [DPI])

Question 36

Vastus lateralis site

Answer 36

usually recommended site
for infants and children younger than 2 years
ofage.
can take up to 2mL

Question 37

ventral gluteal

Answer 37

after age 2

-can take up to 2mL

Question 38

solution volume less

than 0.5 mL

Answer 38

tuberculin syringe

Question 39

IM injections appropriate for

Answer 39

Appropriate for irritating medications, solutions in

oils, and aqueous suspensions.

Question 40

z-track

Answer 40

Type of IM injection that prevents medication
from leaking back into subcutaneous tissue
example iron injection which would stain skin

Question 41

Preferred site of IV

Answer 41

peripheral vein in hand or arm

Question 42

IV specs

Answer 42

Vascular access devices can be for short-term use
(catheters) or long-term use (infusion ports). Use
16-gauge for trauma clients, 18-gauge for surgical
clients, and 22- to 24-gauge for children, older adults,
medical clients, and stable postoperativeclients.

Question 43

Epideral

Answer 43

• intravenous opioid analgesia
  (morphine [Duramorph] or fentanyl [Sublimaze]).

-A catheter is advanced through a needle that is
inserted into epidural space at the level of fourth
or fifth vertebrae.

Question 44

luminal (phenobarbital)

Answer 44

short term use for insomnia; anxiety; stroke