Exam 1 Flashcards
Stages of pharmocokinetics
- absorption
- distribution
- metabolism
- excretion
Explain excretion
Elimination of meds from body
Explain absorption
Transmission of meds from administration location to bloodstream
Explain metabolism
Changes meds into less active forms by actions of enzymes
Explain distribution
Transportation of meds to sites of action by body fluids
Oral route of administration
Barriers: meds need to pass through layer of epithelial cells that line GI track
Absorption pattern: varies greatly based on stability/solubility of med, GI pH, food in stomach, form of med (liquid/enteric encoated)
Sublingual route of administration
Barriers: swallowing before dissolution allows gastric pH to inactivate med
Absorption pattern: quickly through the highly vascular mucous membranes
Inhalation route of administration
Barriers: inspiratory effort
Absorption pattern: rapid through alveolor capillary networks
Subcutaneous route of admission
Barriers: no significant barrier, capillary walls have large spaces between cells
Absorption pattern: solubility of med in water (higher solubility = higher absorption) and blood perfusion at site of injection (higher perfusion = rapid)
Intravenous route of administration
Barriers: none
Absorption pattern: immediate (directly into bloodstream) and complete (reaches blood in its entirety)
Fastest route of administration
Intravenous
Slowest route of administration
Oral
10 “rights” to medication administration
Client
Medication
Dose
Time
Route
Documentation
Education
Refuse
Assessment
Evaluation
Phlebitis
Inflammation of the vein
Extravasation
Infiltration of vesicant (highly irritating) medication into tissues surrounding veins
Infiltration
Administration of non-vesicant solution into tissues surrounding vein
Colloids
Maintain a high osmotic pressure in the blood and stays in intravascular space longer
Ex: albumin, dextran
Crystalloids
Increase intravascular volume when it is reduced from hemorrhage, dehydration, or loss of fluids
Ex: 0.9% NaCl, DSW, LR
Isotonic
Balance of water and solutes
Ex: 0.9%NaCl, 5% dextrose in water, LR
Hypertonic
To move fluid out of cells
Ex: dextrose 10% in water (D5W), 3% NaCl
Hypotonic
To move fluid into cells
Ex: 0.45% NaCl
What hormones are responsible for the regulation of fluid and electrolytes
Aldosterone, antidiuretic hormone (ADH) (vasopressin), natriuretic peptides (NPs)
What is the primary function to help regulate blood pressure
Aldosterone
What does aldosterone do in the body
Signals the kidney and colon to increase the amount of sodium sent into the bloodstream which causes the water to retain water in the blood which increases blood volume
What does antidiuretic hormone (ADH) (vasopressin) do in the body
Affects fluid volume by reducing amount of water passed out in urine or returning more water to bloodstream; decreases blood pressure during dehydration or hemorrhage
high levels = retain water in body
low levels = excrete too much water
What does natriuretic peptides (NPs) do in the body
Synthesized by heart, brain, and other organs and secreted in response to the increased blood volume and pressure usually in response to heart failure
actions = reduce arterial pressure by decreasing blood volume and systemic vascular resistance
What happens when blood osmolarity decreases?
Supresses ADH
Interventions if urine output is not enough (less than 30cc per hour)
Indicator of perfusion (post op/shock)
pharm therapy = diuretics, ACE inhibitors, ARBs, direct renin inhibitors
s/s of fluid deficit in adults
Increased heart rate, weak peripheral pulses, orthostatic or postural hypotension, poor skin turgor, dry flakey skin, increased respiratory rate
s/s of fluid deficit in infants and children
Dry mouth and tongue, lack of tears, no wet diaper for 3 hours, sunken eyes cheeks and fontanels, listlessness and irritability
Causes of fluid deficit
vomiting, diarrhea, diaphoresis, burns, severe wounds, long term NPO, diuretic therapy, GI suction, diabetes, impaired thirst, fever
s/s of fluid overload
increased pulse, high BP, decreased pulse pressure, elevated central venous pressure, distended neck and hand veins, weight gain, increased RR, SOB, shallow RR, moist crackles, pitting edema, AMS, paresthesia, enlarged liver, increased motility
Causes of fluid overload
excessive fluid replacement, kidney failure (end stage), heart failure, long term corticosteroid therapy, psychiatric disorders with polydipsia, water intoxication
Common type of fluid overload
hypervolemia
Interventions for fluid deficit
fluid replacement (oral fluids, pedialyte, IV fluids), drug therapy (antiemetics, antipyretics, desmopressin for diabetes), monitor I and O to ensure it is working
Interventions for fluid overload
remove excess fluid (diuretics like furosemide - loop diuretic), fluid restriction, watch for skin breakdown, I&O and weight to ensure it is working
Postural hypotension
change in bp from lying to sitting or sitting to standing
can be from hypoglycemia
Manifestations of hyponatremia
SALT LOSS
seizure/stupor
abdominal cramping/confusion
lethargic
tendon reflexes diminished/trouble concentrating
loss of urine and appetite
orthostatic hypotension/overactive bowel sounds
shallow respirations (later on)
spasms of muscle
Interventions for hyponatremia
drug and nutrition therapy to restore sodium (bring up slowly)
drugs = reduce drugs like diuretics (those increase sodium loss), prescribe IV saline, drugs that promote excretion of water instead of sodium
for mild hyponatremia oral sodium intake and restrict fluid intake
s/s of hypernatremia
vary depending on if hyper or hypovolemia is present
short attention span, agitated, confused, stupor, lethargy, muscle twitching, muscle contractions, weaker muscles over time, deep tendon reflexes reduced, increased pulse for hypotension, descreased heart rate for hypertension
Interventions for hypernatremia
diuretics to promote sodium loss (furosemide, bumetanide) - typically when others ineffective, heavy hitter
nutrition therapy - dietary sodium restriction
biggest concern for hyponatremia
neuro and dehydration
risk factors for hypokalemia
excessive fluid loss, diuretic drugs (loop like lasix), kidney disease, corticosterioids, cushings syndrome, wound drainage (GI), HF,
risk factors for hyperkalemia
over ingestion of potassium, rapid infusion, burns, crush injuries, kidney failure, adrenal insuffiency, acidosis, diabetes, MI, salt substitutes
hyperkalemia manifestations
bradycardia, hypotension, ECG changes of tall peaked T waves, asystole, and V-fib, twitching, tingling, burning sensations, numbness, increased motility with diarrhea, hyperactive bowel sounds, watery bowel movements
temporary fixes for hyperkalemia
first administer insulin 10-15 units of regular along with 50mL of 50% dextrose to prevent hypoglycemia, if ECG changes to tall peaked T waves, give calcium gluconate first to stablize cardiac muscle.
also give bicarbonate (1 ampule over 5 min) to stimulate na/k pumps
albuterol as nebulizer by lowering levels of k by promoting its movement into cells
Interventions for hypokalemia
give PIV potassium 20mEq/100mL or postassium supplements (with plenty of water and sitting up for 30 min to prevent esophagitis)
more permanent fixes for hyperkalemia
loop diuretics (furosemide), sodium polystyrene sulfonate (kayexalate), dialysis, hemodialysis
Hypocalcemia history
orthopedic surgery, bone healing, thyroid surgery, irradiation of the upper middle chest and neck area, recent anterior neck injury
hypocalcemia s/s
paresthesia, frequent muscle spasms, trousseaus sign, chvosteks sign, weak and thready pulse, hyperactive BS, cramping, diarrhea, osteoporosis, scoliosis
2 clinical manifestations of hypocalcemia
trousseaus sign (spasm or palmer flexion after BP cuff inflation)
chvosteks sign (facial twitching after tapping the ipsilateral cheek)
