Pharmacokinetics and Drug Administration basics
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Questions and Answers

A medication is administered intravenously. How does this route of administration affect the absorption phase of pharmacokinetics?

  • It enhances absorption due to increased blood flow at the injection site.
  • It delays absorption due to the need for the drug to pass through the GI tract.
  • It slows absorption because the drug must first be metabolized by the liver.
  • It bypasses the absorption phase, leading to immediate bioavailability. (correct)

A patient with liver cirrhosis is prescribed an oral medication that undergoes significant first-pass metabolism. What adjustment to the medication regimen is most likely necessary?

  • Decrease the dosage of the medication to prevent drug accumulation. (correct)
  • Administer the medication with food to enhance absorption.
  • Increase the dosage of the medication to compensate for reduced metabolism.
  • Administer the medication intravenously to bypass the liver.

A drug has a half-life of 6 hours. If a dose of 200 mg is administered, how much drug will remain in the body after 12 hours, assuming first-order kinetics?

  • 50 mg (correct)
  • 100 mg
  • 25 mg
  • 75 mg

A drug with a narrow therapeutic index requires close monitoring because:

<p>The difference between the effective dose and toxic dose is small. (D)</p> Signup and view all the answers

Losartan is prescribed to block angiotensin II receptors. This drug is classified as:

<p>An antagonist (C)</p> Signup and view all the answers

Which of the routes of administration listed has the fastest rate of absorption?

<p>Sublingual (D)</p> Signup and view all the answers

A patient is prescribed a medication 'PRN'. What does this order indicate regarding medication administration?

<p>The medication is given as needed based on the patient's condition. (A)</p> Signup and view all the answers

Which of the following factors would most significantly affect the distribution of a drug to the tissues?

<p>Plasma protein binding (A)</p> Signup and view all the answers

A nurse is preparing to administer medication. Which action demonstrates the 'Right Documentation'?

<p>Recording the medication administered immediately after administration. (A)</p> Signup and view all the answers

A patient refuses to take their prescribed medication. What is the priority nursing action?

<p>Document the patient's refusal and inform the provider. (B)</p> Signup and view all the answers

Which of the following medication combinations represents a 'look-alike/sound-alike' medication pair that requires extra caution?

<p>Buspirone and Bupropion (C)</p> Signup and view all the answers

During medication reconciliation, when should a nurse compare a patient's current medications with newly prescribed medications?

<p>At admission, transfer, and discharge. (C)</p> Signup and view all the answers

A patient receiving IV therapy exhibits swelling, pallor, and coolness at the insertion site. Which complication is the MOST likely cause?

<p>Infiltration (C)</p> Signup and view all the answers

Which of the following findings indicates fluid overload in a patient receiving IV therapy?

<p>Edema, crackles in the lungs, and hypertension. (B)</p> Signup and view all the answers

A patient is prescribed alprazolam for anxiety. What is the primary mechanism of action of this medication?

<p>Enhances GABA inhibitory effects in the CNS. (D)</p> Signup and view all the answers

A patient taking zolpidem reports experiencing daytime sleepiness. What is the MOST appropriate nursing intervention?

<p>Advise the patient to avoid driving or operating machinery. (A)</p> Signup and view all the answers

A patient taking venlafaxine for generalized anxiety disorder reports experiencing increased sweating and dizziness. What is the most appropriate initial nursing intervention?

<p>Assess the patient's blood pressure and heart rate, and notify the healthcare provider of any significant elevations. (C)</p> Signup and view all the answers

A patient with major depressive disorder is prescribed duloxetine. Which of the following instructions should the nurse emphasize to the patient regarding discontinuation of the medication?

<p>Taper off the medication gradually under the guidance of a healthcare provider. (C)</p> Signup and view all the answers

A patient taking Amitriptyline reports experiencing dry mouth and constipation. Which of the following interventions is most appropriate for the nurse to recommend?

<p>Encourage the patient to increase fluid and fiber intake. (C)</p> Signup and view all the answers

A patient is prescribed Imipramine for depression. The nurse reviews the patient's medication list and notes that the patient is also taking a monoamine oxidase inhibitor (MAOI). What is the nurse's priority action?

<p>Hold the imipramine and notify the prescribing physician about the potential for serotonin syndrome. (C)</p> Signup and view all the answers

Which of the following assessment findings would be most concerning in a patient who has overdosed on a tricyclic antidepressant (TCA)?

<p>QT prolongation and signs of arrhythmia on the ECG. (B)</p> Signup and view all the answers

Which of the following non-opioid anesthetics carries the highest risk of bacterial infection?

<p>Propofol (A)</p> Signup and view all the answers

A patient is prescribed an SSRI. What critical information should the nurse include in the patient's education regarding the medication's therapeutic effect?

<p>The medication typically takes 4-6 weeks to reach its full therapeutic effect. (C)</p> Signup and view all the answers

A patient receiving ketamine as an anesthetic reports experiencing visual hallucinations post-procedure. Which of the following nursing interventions is most appropriate?

<p>Immediately notify the healthcare provider and document the occurrence. (D)</p> Signup and view all the answers

A patient taking an SSRI reports experiencing increased anxiety and insomnia since starting the medication. Which of the following is the most appropriate initial nursing intervention?

<p>Inform the patient that these side effects are common and usually subside within a few weeks. (A)</p> Signup and view all the answers

A patient who has been taking paroxetine for several months abruptly stops the medication. Which of the following symptoms is the patient most likely to experience as a result of withdrawal?

<p>Flu-like symptoms, insomnia, and dizziness. (C)</p> Signup and view all the answers

A patient is being discharged on sertraline. What information is most important for the nurse to emphasize regarding potential drug interactions?

<p>Sertraline should not be combined with MAOIs, TCAs, or St. John's Wort due to the risk of serotonin syndrome. (A)</p> Signup and view all the answers

During a surgical procedure, a patient receiving a non-opioid anesthetic experiences significant respiratory depression. Which of the following actions should the nurse prioritize?

<p>Prepare for and assist with mechanical ventilation. (C)</p> Signup and view all the answers

A nurse is caring for a young adult patient who has just started taking fluoxetine. What is the most critical nursing intervention related to the black box warning for this medication?

<p>Assessing the patient for signs of increased suicidal ideation. (A)</p> Signup and view all the answers

A patient taking an MAOI is preparing to switch to a different antidepressant. What is the MOST important instruction regarding the transition?

<p>Complete a 2-4 week washout period after stopping the MAOI before starting the new antidepressant. (B)</p> Signup and view all the answers

A patient prescribed an MAOI is educated about dietary restrictions. Which meal choice indicates that the patient UNDERSTANDS the teaching?

<p>Grilled chicken salad with a vinaigrette dressing and apple juice. (B)</p> Signup and view all the answers

Which of the following lab values requires close monitoring for a patient prescribed Carbamazepine?

<p>Complete Blood Count (CBC) (C)</p> Signup and view all the answers

A patient taking Lamotrigine reports developing a rash. What is the priority nursing action?

<p>Instruct the patient to stop taking Lamotrigine immediately and seek medical attention. (A)</p> Signup and view all the answers

What is the MOST important teaching point for a patient newly prescribed Lithium?

<p>Maintain a consistent daily fluid intake and sodium levels. (C)</p> Signup and view all the answers

A patient on Clozapine is scheduled for regular lab work. Which lab value is MOST critical to monitor due to the risk of a potentially fatal side effect?

<p>White Blood Cell count (D)</p> Signup and view all the answers

Which of the following findings is a sign of Lithium toxicity?

<p>Ataxia, coarse tremors, and confusion (A)</p> Signup and view all the answers

A patient is prescribed Buspirone for anxiety. What information should the nurse include in the patient's education about this medication?

<p>It may take 2-4 weeks to achieve its full therapeutic effect. (A)</p> Signup and view all the answers

Flashcards

Absorption

Movement of drugs from the site of administration into the bloodstream.

Factors affecting Absorption

Includes route, drug solubility, gastric pH/motility, and blood flow.

Distribution

Transport of drugs to target tissues via the bloodstream.

Metabolism

Drug breakdown primarily in the liver.

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First-pass Effect

The liver inactivates oral drugs before they reach systemic circulation.

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Excretion

Elimination of drugs, mainly via kidneys (urine).

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Therapeutic Index (TI)

The range of drug concentration between effective and toxic levels.

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Agonists vs Antagonists

Agonists activate receptors, while antagonists block them.

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Right Medication

Verify the medication label three times before administration.

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Right Dose

Use appropriate measuring devices to ensure the correct dosage.

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Right Time

Administer medication within 30 minutes of the scheduled time.

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High-Alert Medications

Medications that require extra caution, e.g., Insulin, Heparin.

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Medication Reconciliation

Comparing current medications with new prescriptions at transitions.

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Sedative Hypnotics

Medications like Alprazolam that enhance GABA in the CNS for anxiety.

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Infiltration Complication

Swelling and coolness at the IV site indicating fluid leakage.

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SSRIs for Anxiety Disorders

Medications like Paroxetine used to treat various anxiety disorders.

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IV Non-Opioid Anesthetics

Medications used for anesthesia that are not opioids, such as barbiturates, benzodiazepines, propofol, and ketamine.

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Methohexital Sodium

A barbiturate used as a fast-acting anesthetic for induction of anesthesia.

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SSRIs

Selective Serotonin Reuptake Inhibitors that increase serotonin levels in the brain to treat depression and anxiety.

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Serotonin Syndrome

A potentially life-threatening condition caused by excess serotonin, leading to symptoms like hyperthermia and muscle rigidity.

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Black Box Warning for SSRIs

A warning indicating a risk of suicide, particularly in young adults taking SSRIs.

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Ketamine Risks

Side effects of ketamine include hallucinations and mental confusion after use.

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Nursing Considerations for SSRIs

Monitor for withdrawal symptoms and signs of serotonin syndrome; do not stop medications abruptly.

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Common SSRIs

Medications include Escitalopram, Fluoxetine, Sertraline, Paroxetine, Citalopram, and Fluvoxamine.

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SNRIs Side Effects

Include hypertension, tachycardia, sweating, dizziness, sexual dysfunction.

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Risk of Serotonin Syndrome

Potential danger when SNRIs combine with SSRIs, MAOIs, or St. John's Wort.

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Tricyclic Antidepressants (TCAs)

Antidepressants like Amitriptyline and Nortriptyline that inhibit serotonin/norepinephrine reuptake.

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MAOIs

Medications that inhibit monoamine oxidase, increasing serotonin, dopamine, norepinephrine.

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Common MAOI Medications

Includes Nardil, Parnate, Marb Plan, Selegiline.

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Uses of MAOIs

Used for treatment-resistant depression, atypical depression, and panic disorder.

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MAOI Side Effects

Includes hypertensive crisis and serotonin syndrome; dizziness, weight gain, insomnia, sexual dysfunction.

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Tyramine Foods to Avoid

Aged cheese, cured meats, red wine, beer, fermented foods.

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Lithium Therapeutic Range

Normal range is 0.6 - 1.2 mEq/L for lithium treatment of mood disorders.

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Carbamazepine Risks

Risks include agranulocytosis and Steven-Johnson syndrome; monitor CBC.

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Benzodiazepines

Includes Alprazolam, Lorazepam; used for short-term anxiety management.

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Study Notes

Pharmacokinetics & Routes of Administration

  • Absorption: Movement of drugs from the site of administration into the bloodstream
    • Factors affecting absorption include: route of administration (IV is fastest, oral is slowest), drug solubility (lipid-soluble drugs absorb better), gastric pH and motility, blood flow at the administration site.
    • Absorption by route: oral (PO) has variable absorption due to gastric pH, food, motility; Intramuscular/Subcutaneous is fast if water-soluble; slow if poorly soluble; Intravenous (IV) has immediate effect.
  • Distribution: Transport of drugs to target tissues via the bloodstream
    • Factors affecting distribution include blood flow/perfusion, plasma protein binding (albumin), blood-brain barrier, and placenta permeability.
  • Metabolism: Drug breakdown, mainly in the liver
    • Factors affecting metabolism include first-pass effect (liver inactivates oral drugs), age (infants and elderly have slower metabolism), hepatic enzyme induction/inhibition.
  • Excretion: Elimination of drugs, mainly via the kidneys (urine)
    • Monitoring: Assess BUN and creatinine for kidney function.

Key Pharmacokinetic Concepts

  • Therapeutic Index (TI): High TI = safe, less monitoring; Low TI = Risky, requires blood level monitoring.
  • Half-Life (t½): Short t½ = frequent dosing; Long t½ = higher risk of toxicity.

Safe Medication Administration & Error Reduction

  • Medication Orders: Routine (Standing), Single (One-time), Stat, PRN (as needed)
  • Rights of Medication Administration: Right Client, Right Medication, Right Dose, Right Time, Right Route, Right Documentation, Right Education, Right to Refuse.
  • High-Alert & Confused Medications: Insulin, Heparin, Opioids, Warfarin, Buspirone vs. Bupropion, Clonidine vs. Clonazepam, Prednisone vs. Prednisolone
  • Medication Reconciliation: Compare current meds with new prescriptions; Resolve discrepancies before administering.

Intravenous (IV) Therapy

  • IV Medication Administration: Peripheral IV (short-term), Central IV (long-term), Continuous Infusion, IV Bolus (Push), Piggyback (secondary IV line).
  • Safe IV Administration: Monitor for complications including infiltration, extravasation, phlebitis, and fluid overload.

Anxiety & Trauma-Related Medications

  • Sedative Hypnotic Anxiolytics (Benzodiazepines)
    • Prototype: Alprazolam
    • Other (Diazepam, Lorazepam, Clonazepam, Chlordiazepoxide, Clorazepate, Oxazepam)
    • Purpose: Enhances GABA inhibitory effects in the CNS
    • Uses: GAD, Panic Disorder, Seizures, Insomnia, Alcohol Withdrawal
  • Nonbenzodiazepines (Zolpidem, Eszopiclone): Enhance GABA, short-term for insomnia. Complications include daytime sleepiness, lightheadedness.
  • SSRIs for Anxiety Disorders: Paroxetine, Sertraline, Escitalopram, Fluoxetine, Fluvoxamine.

Sedative-Hypnotics & Intravenous Anesthetics

  • IV Non-Opioid Anesthetics
    • Medications: Barbiturates (Methohexital Sodium), Benzodiazepines (Midazolam, Diazepam, Lorazepam), Other (Propofol, Ketamine)
  • Complications: Respiratory and cardiovascular depression, potential for bacterial infection (Propofol), hallucinations/mental confusion (Ketamine).

Mood Stabilizers

  • Lithium: Therapeutic range (0.6-1.2 mEq/L), monitor Sodium & Hydration, toxicity S/S include: N/V, Ataxia, Coarse Tremors.
  • Valproate (Depakote): Black Box Warning: hepatotoxicity, pancreatitis, teratogenic risk.
  • Carbamazepine: Risk for agranulocytosis (monitor CBC), Steven-Johnson Syndrome.
  • Lamotrigine: STOP if rash develops (Steven-Johnson Syndrome!).

Antipsychotics

  • 1st Generation (Typical): Haloperidol, Chlorpromazine
  • Side Effects: EPS (Tardive Dyskinesia, Parkinsonism, Akathisia, Dystonia), Neuroleptic Malignant Syndrome (NMS).
  • 2nd Generation (Atypical): Clozapine, Risperidone, Olanzapine, Quetiapine.
  • Side Effects: Less EPS, but more metabolic effects (Weight Gain, Diabetes, Hyperlipidemia).

Anxiolytics

  • Benzodiazepines (Alprazolam, Lorazepam, Clonazepam, Diazepam): Short-term use only.
  • Buspirone: Non-sedating, slow onset (2-4 weeks).

CNS Stimulants

  • Methylphenidate, Amphetamine (Adderall)
  • Risk for dependence, weight loss, insomnia

Monoamine Oxidase Inhibitors (MAOIs)

  • Common Medications (Nardil, Parnate, Marplan, Selegiline)
  • Mechanism of Action: Inhibits monoamine oxidase, increasing serotonin, dopamine, norepinephrine.
  • Uses: Treatment-resistant Depression, Atypical Depression, Panic Disorder.
  • Side Effects: HYPERTENSIVE CRISIS, Serotonin Syndrome.
  • Must-Know: Avoid Tyramine Foods (Aged Cheese, Cured Meats, Red Wine, Beer, Fermented Foods), requires 2-4 week washout before switching medications.

Other Information

  • Nursing Considerations: Monitor BP Closely, Strict Diet Teaching.
  • Specific warnings for various medications: high-lethality in overdose, potential for serotonin syndrome, care with specific food interactions.

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Test your knowledge of pharmacokinetics, including drug absorption, distribution, metabolism, and excretion. Explore routes of administration, half-life calculations, and factors influencing drug distribution. Assess your understanding of therapeutic index and drug classifications.

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