Podcast
Questions and Answers
What action should the nurse take to verify the trough level of a medication?
What action should the nurse take to verify the trough level of a medication?
- Ask the client to provide a urine specimen after the next dose of medication.
- Administer the medication, and obtain a blood specimen 30 min later.
- Verify that the client has been taking the medication for 24 hr before obtaining a blood specimen.
- Obtain a blood specimen immediately prior to administering the next dose of medication. (correct)
Medications with long half-lives remain at therapeutic levels between doses for short periods of time.
Medications with long half-lives remain at therapeutic levels between doses for short periods of time.
False (B)
What should be done before applying a transdermal patch?
What should be done before applying a transdermal patch?
Wash the skin with soap and water and dry it thoroughly.
The client should apply the patch to a ______ area of skin to promote absorption.
The client should apply the patch to a ______ area of skin to promote absorption.
Which position should the client be in to facilitate the instillation of eye drops?
Which position should the client be in to facilitate the instillation of eye drops?
What is the correct method for dropping medication into the eye?
What is the correct method for dropping medication into the eye?
How many times per day should the nurse expect to administer phenobarbital for a client with a seizure disorder if it has a half-life of 4 days?
How many times per day should the nurse expect to administer phenobarbital for a client with a seizure disorder if it has a half-life of 4 days?
Which factors should the educator include as a reason to administer lower medication dosages? (Select all that apply)
Which factors should the educator include as a reason to administer lower medication dosages? (Select all that apply)
Which actions should the nurse take when preparing to administer eye drops? (Select all that apply)
Which actions should the nurse take when preparing to administer eye drops? (Select all that apply)
What should clients do while the sublingual tablet is in place?
What should clients do while the sublingual tablet is in place?
What is the purpose of a spacer when using a metered-dose inhaler (MDI)?
What is the purpose of a spacer when using a metered-dose inhaler (MDI)?
Nasal drops should be sprayed into the nose while the client inhales, and the client should not blow their nose for ______ minutes after administration.
Nasal drops should be sprayed into the nose while the client inhales, and the client should not blow their nose for ______ minutes after administration.
What does pharmacokinetics refer to?
What does pharmacokinetics refer to?
Which of the following can be barriers to absorption? (Select all that apply)
Which of the following can be barriers to absorption? (Select all that apply)
Oral medications have no barriers to absorption.
Oral medications have no barriers to absorption.
What is the absorption pattern for intravenous administration?
What is the absorption pattern for intravenous administration?
Where does the metabolism of medications primarily occur?
Where does the metabolism of medications primarily occur?
The time for the medication in the body to drop by 50% is called the ______.
The time for the medication in the body to drop by 50% is called the ______.
What occurs during the first-pass effect?
What occurs during the first-pass effect?
What is the safety margin indicated by a high therapeutic index?
What is the safety margin indicated by a high therapeutic index?
Which of the following factors can influence the rate of metabolism? (Select all that apply)
Which of the following factors can influence the rate of metabolism? (Select all that apply)
Agonists mimic the receptor activity of endogenous compounds.
Agonists mimic the receptor activity of endogenous compounds.
What is pharmacodynamics?
What is pharmacodynamics?
Medications directly applied to the skin and mucous membranes are referred to as ______ medications.
Medications directly applied to the skin and mucous membranes are referred to as ______ medications.
How many times per day should the nurse expect to administer phenobarbital, which has a long half-life of 4 days?
How many times per day should the nurse expect to administer phenobarbital, which has a long half-life of 4 days?
Which of the following factors should a nurse educator include as reasons to administer lower medication dosages? (Select all that apply)
Which of the following factors should a nurse educator include as reasons to administer lower medication dosages? (Select all that apply)
Which actions should the nurse take when administering eye drops to a client? (Select all that apply)
Which actions should the nurse take when administering eye drops to a client? (Select all that apply)
What should clients do after instilling ear drops?
What should clients do after instilling ear drops?
True or False: Clients should not eat or drink while a sublingual tablet is in place until it has completely dissolved.
True or False: Clients should not eat or drink while a sublingual tablet is in place until it has completely dissolved.
For nasal spray, the tip should be inserted into the ______ and pointed away from the center of the nose.
For nasal spray, the tip should be inserted into the ______ and pointed away from the center of the nose.
Match the following medication administration routes with their advantages and disadvantages:
Match the following medication administration routes with their advantages and disadvantages:
What should the nurse do to verify the trough level of the client’s medication?
What should the nurse do to verify the trough level of the client’s medication?
Why should the client apply a transdermal patch to a hairless area of skin?
Why should the client apply a transdermal patch to a hairless area of skin?
Increased renal excretion increases the concentration of the medication.
Increased renal excretion increases the concentration of the medication.
Which of the following statements about medications with long half-lives is correct?
Which of the following statements about medications with long half-lives is correct?
What should a client do just before applying a transdermal patch?
What should a client do just before applying a transdermal patch?
What happens when two medications compete for metabolism?
What happens when two medications compete for metabolism?
What does pharmacokinetics refer to?
What does pharmacokinetics refer to?
What are the common routes of medication administration?
What are the common routes of medication administration?
Oral medications pass through a layer of epithelial cells in the GI tract before absorption.
Oral medications pass through a layer of epithelial cells in the GI tract before absorption.
Which of the following is a barrier to absorption?
Which of the following is a barrier to absorption?
What is the primary site of metabolism in the body?
What is the primary site of metabolism in the body?
The time for the medication in the body to drop by 50% is referred to as _________.
The time for the medication in the body to drop by 50% is referred to as _________.
What are agonists in pharmacodynamics?
What are agonists in pharmacodynamics?
Nurses should monitor medications with a low therapeutic index closely.
Nurses should monitor medications with a low therapeutic index closely.
When is peak level monitoring crucial for oral medications?
When is peak level monitoring crucial for oral medications?
What can kidney dysfunction lead to in medication response?
What can kidney dysfunction lead to in medication response?
What role do antagonists play in pharmacodynamics?
What role do antagonists play in pharmacodynamics?
Study Notes
Medication Administration (Inhaler)
- Tilt head back slightly and inhale slowly and deeply for 3 to 5 seconds.
- Hold breath for 10 seconds.
- Remove mouthpiece and exhale slowly through pursed lips.
Medication Administration (Eye Drops)
- Look upward to prevent drops from falling onto the cornea.
- Do not blink, but if you do, repeat the instillation.
- Drop medication into the conjunctival sac.
- Close eye gently.
Medication Administration (Transdermal Patch)
- Apply the patch to a hairless area of skin.
Medication Administration (Trough Levels)
- Obtain blood specimen immediately before administering the next dose of medication.
- Trough levels reflect the least concentration of the medication in the blood.
Pharmacokinetics
- The study of how medications travel through the body
- Involves absorption, distribution, metabolism, and excretion
Absorption
- The movement of medications from the administration site to the bloodstream
- Common routes include enteral (GI tract) and parenteral (injection)
- Rate of absorption affects the onset of action
- Amount absorbed determines the intensity of effects
Barriers to Absorption
- Oral: Medications must pass through the GI tract epithelial cells
- Sublingual/buccal: Swallowing before dissolution can inactivate medications in the stomach
- Inhalation: Inspiratory effort is a barrier
- Intradermal/topical: Close proximity of epidermal cells
- Subcutaneous/intramuscular: Capillary walls have large spaces, no significant barrier
- Intravenous: No barriers
Absorption Patterns
- Oral: Varies greatly due to medication stability, solubility, GI pH, emptying time, and other medications
- Sublingual/buccal: Quick systemic absorption through highly vascular mucous membranes
- Inhalation: Rapid absorption through alveolar capillary networks
- Intradermal/topical: Slow, gradual absorption, primarily local effects, but systemic with lipid-soluble medications
- Subcutaneous/intramuscular: Solubility of medication in water determines absorption rate; highly soluble medications are absorbed quickly, poorly soluble ones are absorbed slowly
- Intravenous: Immediate and complete absorption, entering directly into the bloodstream
Distribution
- The transport of medications to their sites of action by bodily fluids
- Influenced by circulation, cell membrane permeability, and plasma protein binding
Metabolism
- The process of changing medications into less active forms by enzymes
- Primarily occurs in the liver, but also in kidneys, lungs, intestines, and blood
Factors Affecting Metabolism Rate
- Age: Infants have limited capacity, aging can affect it, older adults require smaller doses
- Enzyme increases: Can metabolize a medication faster, requiring increased dosage
- First-pass effect: Liver inactivates some medications on their first pass, requiring a non-enteral route for medications with a high first-pass effect
- Similar metabolic pathways: Can alter the metabolism of multiple medications
- Nutritional status: Malnourishment can impair medication metabolism
Outcomes of Metabolism
- Inactivation of medications
- Increased therapeutic effects
- Activation of pro-drugs
- Decreased toxicity
- Increased toxicity
Excretion
- Elimination of medications from the body
- Primarily occurs through the kidneys
- Also occurs through the liver, lungs, intestines, and exocrine glands (e.g., breast milk)
- Kidney dysfunction can lead to medication accumulation and increased duration/intensity of response
Medication Responses
- Therapeutic range: Effective and not toxic
- Therapeutic index (TI): Wide safety margin for high TI medications, low TI medications require close monitoring
- Peak levels: Highest plasma level when elimination = absorption
- Trough Levels: Obtained immediately before the next dose
- Plateau: Steady concentration in plasma during a series of doses
Half-Life (t½)
- Time for medication levels to decrease by 50%
- Affects the time to reach steady state
- Short half-life: Medications leave the body quickly, short dosing intervals
- Long half-life: Medications leave the body slowly, longer dosing intervals, increased risk of accumulation
Pharmacodynamics
- The interaction of medications with target cells, body systems, and organs to produce effects
- Involves agonist, antagonist, and partial agonist medications
Agonists
- Medications that bind to and mimic the activity of endogenous compounds
- Activate receptors to produce effects (e.g., morphine at opioid receptors)
Antagonists
- Block receptor activity of endogenous compounds or other medications
- Prevent the action of the targeted compound (e.g., losartan at angiotensin II receptors)
Partial Agonists
- Act as both agonists and antagonists
- Have limited affinity to receptor sites
- May produce limited effects or block the effects of strong agonists (e.g., nalbuphine at opioid receptors)
Oral Route (Enteral)
- Common and convenient
- Advantages: Inexpensive, easy to administer
- Disadvantages: Variable absorption, inactivation in GI tract, requires cooperation
Sublingual and Buccal
- Sublingual: Under the tongue
- Buccal: Between the cheek and gum
- Bypass the liver, directly enter the bloodstream
Topical Route
- Medications applied to mucous membranes or skin
- Include powders, sprays, creams, ointments, pastes, and lotions
- Limited adverse effects
- Painless
Transdermal Route
- Medications in a skin patch for absorption through the skin
- Produce systemic effects
Eye Route
- Instillations for direct application to the eye
Ear Route
- Instillations for direct application to the ear canal.
Medication Administration: Inhalers
- Tilt head back slightly while pressing the inhaler, and inhale deeply and slowly for 3-5 seconds.
- Hold breath for 10 seconds to allow medication to deposit in airways.
- Remove mouthpiece from mouth and exhale slowly through pursed lips.
Medication Administration: Dosage Adjustments
- Liver failure decreases metabolism, increasing medication concentration. Therefore, dosage should be decreased.
- When two medications are metabolized by the same pathway, they compete for metabolism, increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications.
Medication Administration: Eye Drops
- Look upward to prevent drops from falling onto the cornea
- Drop medication into the conjunctival sac to promote distribution.
- Close eye gently after application to promote distribution.
Medication Administration: Transdermal Patches
- Apply patch to a hairless area of skin to promote absorption.
Medication Administration: Trough Levels
- Trough levels should be measured immediately before administering the next dose of medication to verify the lowest concentration of the medication in the client's blood.
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Description
This quiz covers essential nursing actions and protocols for proper medication administration, including verifying trough levels, applying transdermal patches, instilling eye drops, and understanding dosage considerations. Test your knowledge on best practices and factors influencing medication administration for optimal patient care.
