Valproic acid complications blood dyscrasias leukopenia

Pharmacology Proctored ATI Study Guide

Chapter 1: Pharmacokinetics and Routes of Administration
 Absorption
 Route of admin affects the rate and amount of absorption
o Oral:
 GI pH and emptying time
 Presence of food in the stomach or intestines 
Form of meds (liquid/XR)
o Sublingual/buccal
 Quick absorption systemically through highly vascular mucous
membranes
o Inhalation via mouth/nose
 Rapid absorption through alveolar capillary networks o
Intradermal, topical
 Slow, gradual absorption
o SQ/IM
 Highly soluble meds have rapid absorption (10-30min), poorly soluble have slower absorption
 Blood perfusion at site of injection affect absorption
o IV
 Immediate and complete
 Distribution
o Transportation of meds to sites of action by body fluids
o Plasma binding protein: meds compete for protein binding sites within
bloodstream, primarily albumin. The ability of med to bind to protein can affect how much med will leave and travel to target tissues.

o Tough levels: obtain immediately before next dose.

 Half-life:

 Antagonist: blocks

 Routes of admin:

o Sublingual/buccal

 Keep med in place until completely dissolved

 Place drop in center of sac.

 Avoid placing directly on cornea. 

 Have client lay on unaffected side. 

Up and out for adults

 Take a deep breath and then exhale

 Slow deep breath for 3-5 seconds from MDI

Hold breath for 5-10 seconds

o NG/Gastrostomy tubes

 Insert beyond internal sphincter
 Remain flat or left lateral for 5 min after insertion.

o Intradermal:
 Used for allergy testing
 Used for tb testing
 Small amount of solution (no more than 0.1ml) 10-15-degree angle bevel up.

 Do not reference or include report in clients medical record

 Med errors relate to systems, procedures, product design, or practice patterns. Report all errors to help avoid similar errors in future.

 Rapid and precise

 Circulatory overload is possible if too large or too rapid of an infusion

 Flush every 8-12 hours when not in use

 Avoid tourniquets in older adults

 Wipe all ports with alcohol before using or inserting a syringe

 Complications

encourage active range of motion, apply a cold or warm compress

depending on type of solution that infiltrated, check with provider to

 Treatment: stop infusion, place antidote before removing catheter if

there is one, notify provider.

extremity, surgical removal.

o Phlebitis/thrombophlebitis:

 Pediatric doses based on weight or body surface area

 Most medications are potentially harmful to the fetus  Pregnancy is a contraindication for live-virus vaccine  Pregnant women should get the inactivated flu vaccination

gain, renal toxicity, electrolyte imbalances, Lithium toxicity (confusion, COURSE TREMORS, tinnitus, hypotension, coma and possibly death). Toxic levels >1.5

 Interactions: Diuretics DO NOT TAKE (decreases amount of sodium and thus likelihood of toxicity), NSAIDs (will increase renal absorption and lead to toxicity), anticholinergics

 Antipsychotics: 2nd and 3rd generation (atypical)
o Risperidone/Clozapine
 Controls positive and negative symptoms.

 Complications: DM, Wt. gain, Hypercholesterolemia, Orthostatic hypotension, anticholinergic effects.

o Effects of withdrawal usually start within 4-12 hours of last intake of alcohol and can last 5-7 days: nausea, vomiting, tremors, increased HR/BP/RR, seizures o Withdrawal meds:

 Benzos (also used for cocaine toxicity I think)  Chlordiazepoxide/diazepam/lorazepam o Decrease risk of seizures, maintenance of vital signs WNL

orthostatic hypotension, psychosis, discoloration of sweat and urine (harmless)
 Education: eat less protein, increase carbs 
Anti-epileptics

o Phenytoin/Carbamazepine/Valproic acid/lamotrigine
 Phenytoin:
 Adverse effects: nystagmus, sedation, ataxia, double vision, gingival hyperplasia, skin rash, dysrhythmias, hypotension, coarsening of facial features, hirsutism, interference with Vit D metabolism, interference with Vitamin K dependent clotting factors causing bleeding in newborns

o Barbiturates (pentobarbital), Benzos (midazolam), other meds (Propofol)  Pharm action: loss of consciousness and elimination of response to

painful stimuli