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Pharmacology ATI Study Guide Copy
Adult Health II (NR-325)
Chamberlain University
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ATI Pharmacology Study Guide
Topic 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.
Metabolism o Primarily occurs in the liver but can take place in the kidney o Factors that influence metabolism: ▪ Age (infants/older adults require smaller doses) ▪ First pass effect: liver inactivates some meds on first pass through and thus require sublingual or IV route (may need higher dose)
Excretion: o Eliminated through the kidneys. o Kidney dysfunction can result in elevated levels of medications.
Med Response o Maintain plasma levels between minimum effective concentration and the toxic concentration:
Therapeutic index (TI) o High TI has a wide safety margin. o Low TI requires monitoring of serum levels. o Tough levels: obtain immediately before next dose.
Half-life: o Time it takes a medication level to drop in the body by 50%. o Short vs long half-life: long half-life has greater risk for med accumulation in body.
Agonist: enhance
Antagonist: blocks
Routes of admin: o Oral/Enteral: ▪ 90 degrees upright ▪ do not mix with large amounts of food ▪ lean chin in to help facilitate swallowing o Sublingual/buccal ▪ Keep med in place until completely dissolved o Transdermal ▪ Wash skin with soap and water then dry it thoroughly before placing patch. Place patch on hairless area and rotate sites to prevent irritation. o Drops: ▪ Place drop in center of sac. ▪ Avoid placing directly on cornea. ▪ If blink repeat process. ▪ Apply gentle pressure with finger and a clean facial tissue on the nasolacrimal duct for 30-60 seconds to prevent systemic absorption. o Ears: ▪ Have client lay on unaffected side. ▪ Up and out for adults ▪ Down and back for children o Inhalation: ▪ MDI - Shake vigorously 5-6 times - Take a deep breath and then exhale - Slow deep breath for 3-5 seconds from MDI - Hold breath for 10 seconds after ▪ DPI - DO NOT SHAKE DEVICE - Place mouthpiece between lips and take a deep breath - Hold breath for 5-10 seconds o NG/Gastrostomy tubes ▪ To prevent clogging flush tube before and after each med with 15-30ml of warm sterile water. o Suppositories: ▪ Left lateral sims position. ▪ Insert beyond internal sphincter ▪ Remain flat or left lateral for 5 min after insertion.
Topic 3: Dosage Calculation
- 1kg=1000mg
- 1oz=30mL
- 1L=1000mL
Topic 4: IV Therapy
- Rapid and precise
- Circulatory overload is possible if too large or too rapid of an infusion
- Admin can irritate vein
- Can lead to sepsis if aseptic technique is broken
- Distal veins on nondominant hand first
- Write date/time, document size/site/appearance
- Flush every 8-12 hours when not in use
- Avoid tourniquets in older adults
- Hold hand below heart
- Change every 72 hours
- Change tubing every 24 hours
- Changes fluids every 24 hours
- Wipe all ports with alcohol before using or inserting a syringe
- Complications o Infiltration: ▪ Findings: pallor, local swelling at site, decreased skin temp around site, damp dressing ▪ Treatment: stop infusion and remove catheter, elevate extremity, encourage active range of motion, apply a cold or warm compress depending on type of solution that infiltrated, check with provider to determine whether the IV is still needed. ▪ Prevention: carefully select site and size of catheter, secure the catheter. o Extravasation ▪ Findings: pain, burning, redness, and swelling. ▪ Treatment: stop infusion, place antidote before removing catheter if there is one, notify provider. o Hematoma: ▪ Elevate extremity, use warm compress o Catheter embolus: ▪ Missing catheter tip after discontinuation. Place tourniquet high on extremity, surgical removal. o Phlebitis/thrombophlebitis: ▪ Red line up the arm with palpable band at vein site o Cellulitis- “itis” inflammation of the cells o Fluid overload
Topic 6: Individual Considerations of Medication Administration
- 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
Topic 7: Anxiety and trauma- and stressor-related disorders
- Benzodiazepines o Chlordiazepoxide, alprazolam ▪ Decrease activity of neurons by enhancing inhibitory effects of GABA ▪ Therapeutic use ➔ seizures, muscle spasm, alcohol withdrawal, induction of anesthesia ▪ Complications: CNS depression (sedation, severe resp depression), amnesia, withdrawal effects (addictive) ▪ ADMINISTER FLUMAZEMIL for benzo overdose (reversal) ▪ Contraindications: short term use for risk of dependency ▪ Nursing admin: keep in a secure place due to dependency risk
- Atypical anxiolytic/ nonbarbiturate anxiolytic o Buspirone ▪ Can take long term ▪ Takes 1 week to take effect and 2-6 weeks for full effect ▪ Taken on a scheduled basis ▪ Therapeutic use ➔ panic disorder, OCD, PTSD ▪ Complications: dizziness, nausea, headache ▪ Can take with food
- SSRIs o Sertraline, Paroxetine ▪ Increases serotonin in system ▪ Can take 4 weeks to produce therapeutic medication levels ▪ Ther use insomnia (paroxetine only), OCD, Trauma, Depressive disorders ▪ Complications: sexual dysfunction, weight gain, serotonin syndrome (agitation, hallucinations, tremors, fever, diaphoresis) ▪ Nursing admin: can take up to 4 weeks to have therapeutic effects
Topic 8: Depressive Disorders
SSRIs o Fluoxetine ▪ Increases serotonin in system ▪ Can take 4 weeks to produce therapeutic medication levels ▪ Ther use ➔ insomnia (paroxetine only), OCD, Trauma, Depressive disorders ▪ Complications: sexual dysfunction, weight gain, serotonin syndrome (agitation, hallucinations, tremors, fever, diaphoresis), inability to sleep ▪ Nursing admin: can take up to 4 weeks to have therapeutic effects, taper dose due to possible dependence
Atypical Antidepressants Bupropion
Mood stabilizing antiepileptic drugs o Carbamazepine, Valproic Acid ▪ Complications: blood dyscrasias (leukopenia, anemia, thrombocytopenia- monitor CBC), double vision, nystagmus, hypo-osmolality (monitor serum sodium) ▪ Complications (valproic acid): GI effects, hepatotoxicity, pancreatitis, thrombocytopenia Topic 10: Psychotic Disorders
Meds are used to treat positive symptoms
Know positive vs negative symptoms
Antipsychotics First generation (conventional) o Haloperidol/Chlorpromazine (low potency) ▪ Complications: Extrapyramidal symptoms (acute dystonia – severe spasms of tongue, neck, face, or back, parkinsonism, akathisia- inability to stand or sit still, Tardive dyskinesia (TD) – involuntary movements of tongue and face such as lip-smacking). Neuroleptic Malignant Syndrome
high grade fever, muscle rigidity, dysrhythmias. ▪ Nursing administration: administer anticholinergics, beta-blockers, and benzos to control EPSs. Advise clients can take 2-4 weeks for significant improvement. ▪ Consider Depot preps which are administer IM once every 3-4 weeks for people who have trouble maintaining a regimen.
Antipsychotics: 2nd and 3rd generation (atypical) o Risperidone/Clozapine ▪ Controls positive and negative symptoms. ▪ Complications: DM, Wt. gain, Hypercholesterolemia, Orthostatic hypotension, anticholinergic effects. ▪ Nursing admin: administered IM once every 2 weeks (Risperidone). Topic 11: Meds for children and adolescents who have mental health issues
CNS Stimulants o Methylphenidate/Amphetamine Mixture ▪ ADHD/conduct disorder ▪ Complications: Insomnia, administer last dose before 4pm, decreased appetite, wt. loss ▪ Nursing admin: admin during or immediately after meals, monitor clients weight. Topic 12: Substance Use Disorders ( ASKS ABOUT COCAINE TOXICITY SO THE HIGHLITED STUFF IS MY GUESS AFTER SOME RESEARCH)
Meds to support withdrawal/abstinence from alcohol. 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
▪ Adjunct meds with benzos - Clonidine/propranolol/carbamazepine o Decrease seizures (carbamazepine) o Decrease HR and BP (propranolol/clonidine) o Nursing admin: seizure precautions o Abstinence maintenance ▪ Disulfiram
- If drinks alcohol effects include nausea, vomiting, weakness, sweating, palpitations and hypotension ▪ Naltrexone
- Suppresses craving and pleasurable effects of alcohol.
- Suggest monthly IM injections for clients who have trouble adhering to oral form.
- Meds to support withdrawal/abstinence from opioids o Methadone substitution ▪ Dependence will be transferred from illegal to methadone ▪ Methadone must be slowly tapered
- Meds to support withdrawal/abstinence from nicotine o Bupropion ▪ decreases cravings and withdrawal symptoms. o Nicotine Replacement therapy ▪ Nicotine gum/patch/nasal spray o Varenicline ▪ Reduces cravings for nicotine as well as the severity of withdrawal symptoms. Notify provider if suicidal thoughts or new onset depression occur. Topic 13: Chronic Neurologic Disorders
- Cholinesterase Inhibitors o Neostigmine/Edrophonium ▪ Ther use ➔ reversal of nondepolarizing neuromuscular blocking agents, myasthenia gravis ▪ Complications: Cholinergic Crisis (excessive muscarinic stimulation and resp depression), increased GI motility/secretions, diaphoresis, increased salivation, bradycardia, and urinary urgency ▪ Antidote: Atropine
- Anti-Parkinson’s agents o Levodopa/carbidopa ▪ Ther Use: Parkinson’s ▪ Adverse effects: nausea/vomiting/drowsiness, dyskinesias (tics), orthostatic hypotension, psychosis, discoloration of sweat and urine (harmless) ▪ Education: eat less protein, increase carbs
- Anti-epileptics
▪ Pharm action: block acetylcholine at the neuromuscular junction ▪ Complications: Resp arrest, Malignant hyperthermia – muscle rigidity accompanied by increased temp as high as 109. ▪ Nursing admin: for malignant hyperthermia – O2 at 100%, cooling measures including iced 0%NaCl, admin dantrolene to decrease metabolic activity of skeletal muscle
- Muscle relaxant and antispasmodics o Dantrolene/Baclofen ▪ Purpose:
- Baclofen: produce sedative effects, and depress hyperactive spasticity of muscles o Ther use: Cerebral Palsy, spinal cord injury, and MS
- Dantrolene: inhibits muscle contraction by preventing release of calcium in skeletal muscles o Ther use: Cerebral palsy, spinal cord injury, MS, tx of malignant hyperthermia ▪ Complications:
- Baclofen: nausea, constipation – increase high fiber foods
- Dantrolene: hepatotoxicity, muscle weakness
- Muscarinic agonists o Bethanechol ▪ Pharm action: stimulation of the muscarine receptors of the GU tract ▪ Ther use: nonobstructive urinary retention, usually postop or postpartum ▪ Complications: sweating, urinary urgency, bradycardia, hypotension ▪ Nursing admin: admin PO 1hr before or 2hr after meal to minimize nausea/vomiting
- Muscarinic antagonist o Oxybutynin ▪ Pharm action: inhibit muscarinic receptors of the detrusor muscle of the bladder ▪ Ther use: Overactive bladder ▪ Complications: Anticholinergic effects – instruct clients to drink 2-3 L/day Topic 16: Sedative-Hypnotics
- Nonbenzos o Zolpidem ▪ Pharm action: prolonged sleep durations and decreased awakenings ▪ Ther Use: insomnia ▪ Complications: daytime sleepiness, lightheadedness ▪ Educations: must have time for at least 8 hours of sleep
- Intravenous anesthetics o Barbiturates (pentobarbital), Benzos (midazolam), other meds (Propofol) ▪ Pharm action: loss of consciousness and elimination of response to painful stimuli
▪ Complications - Propofol: use within 6 hours, monitor for signs of infection ▪ Nursing admin: monitor for resp arrest or hypotension, inject Propofol into large vein to decrease pain at injection site Topic 17: Airflow Disorders
- Beta-adrenergic agonists (Albuterol - Short acting, prevention of asthma episode/Salmeterol -Long acting, long term control of asthma) ▪ Complications (for both): tachycardia, angina, tremors ▪ Nursing admin: If has a script for both beta-adrenergic agonist and steroid inhale beta-adrenergic agonist FIRST. Beta-adrenergic agonist promotes bronchodilation and enhances absorption of the steroid. Ensure the clients know the dosage schedule if the med is to be taken on a fixed schedule or a PRN basis.
- Methylxanthines o Theophylline ▪ Complications: GI distress, dysrhythmias, and seizures ▪ Nursing admin: monitor serum levels
- Inhaled anticholinergics o Ipratropium ▪ Ther use: COPD, Allergen-induced and exercise-induced bronchospasm ▪ Complications: dry mouth, hoarseness ▪ Nursing admin: rinse mouth after inhalation to decrease unpleasant taste, usually adult dose is 2 puffs, wait length prescribed amount of time between puffs, wait 5 min between medications.
- Glucocorticoids o Beclomethasone (inhalation) ▪ Purpose: prevent inflammation, long-term prophylaxis of asthma ▪ Complications: hoarseness, candidiasis – advise client to rinse mouth or gargle with water after use, monitor for redness, sores, or white patches and report to provider if they occur. Treat candidiasis with nystatin oral suspension. o Prednisone (oral) ▪ Complications: suppression of adrenal gland function (taper dose), bone loss – perform wt. bearing exercises/consume efficient calcium and vit D, hyperglycemia – DM patients monitor BG/ may need to increase insulin dosage, myopathy – muscle weakness, peptic ulcer disease, infection, hypokalemia o IF CLIENT IS ON LONG-TERM ORAL THERAPY, ADDITIONAL DOSES OF ORAL STEROIDS ARE REQUIRED IN TIEMS OF STRESS, INFECTION, OR TRAUMA
- Leukotriene Modifiers o Montelukast/Zafirlukast ▪ Ther use: long-term therapy of asthma in adults and children, and to prevent exercise induced bronchospasm
▪ Complications: dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia, hyperglycemia ▪ Monitor: electrolyte levels, know therapeutic levels of sodium and potassium, BG, uric acid, calcium, magnesium, lipid levels ▪ Nursing admin: monitor BP and I&Os, usually dosing is 8am and 2pm, infuse IV at 20mg/min, monitor ECG, encourage clients to consume foods high in potassium
Thiazide Diuretics o Hydrochlorothiazide ▪ Pharm action: blocks reabsorption of sodium and chloride, and prevents reabsorption of water ▪ Ther use: hypertension, heart failure, liver and kidney disease ▪ Complications: dehydration, hypokalemia, hyperglycemia ▪ Nursing admin: monitor electrolytes, take first thing in am, consume foods high in potassium and maintain adequate fluid intake, weigh clients same time each day, monitor BP and I&Os, If potassium level drops below 3, monitor ECG and contact provide (may require potassium supplement)
Potassium sparing diuretics o Spironolactone ▪ Pharm action: retains potassium and excretes sodium and water ▪ Ther use: hypertension, heart failure ▪ Complications: Hyperkalemia, impotence, gynecomastia, irregularities of menstrual cycle ▪ Contraindications: do not admin to clients with severe kidney failure ▪ Nursing admin: monitor potassium levels, avoid salt substitutes that contain potassium
Osmotic Diuretics o Mannitol ▪ Pharm action/Ther use: reduce ICP and Intraocular pressure (IOP) ▪ Complications: Heart failure, pulmonary edema, rebound increased ICP, fluid and electrolyte imbalances ▪ Nursing admin: to prevent administering microscopic crystals – use a filter needles when drawing from vial and a filter on the IV tubing, weight daily, I&Os, serum electrolytes (especially Potassium levels) Topic 20: Medications Affecting Blood Pressure
ACE-inhibitors o Captopril/Lisinopril ▪ Pharm action: blocking the conversion of angiotensin I to angiotensin II ▪ Ther use: HTN, heart failure, MI, diabetic/nondiabetic nephropathy ▪ Complications: hypotension, cough, hyperkalemia, rash, angioedema (ACE- Angioedema, Cough, Elevated potassium)
Angiotensin II Receptor Blockers (ARBs) o Losartan/Valsartan ▪ Pharm action: vasodilation ▪ Ther use: HTN, heart failure, diabetic nephropathy, protect against MI ▪ Complications: angioedema, hypotension, GI upset
Aldosterone antagonists o Spironolactone ▪ Pharm action: Blocks aldosterone receptors
Calcium Channel Blockers o Nifedipine/Verapamil/Diltiazem ▪ Nifedipine pharm action: vasodilation of smooth muscle and arteries/arterioles of the heart ▪ Ther use: angina pectoris, HTN ▪ Nifedipine Complications: hypotension, peripheral edema, constipation (also verapamil), dysrhythmias ▪ Verapamil/Diltiazem Interactions: grapefruit juice (avoid) ▪ Nursing admin: monitor BP and HR
Centrally Acting Alpha2 Agonists o Clonidine ▪ Pharm action: results in decreased cardiac output which leads to decreased BP ▪ Ther use: HTN ▪ Complications: drowsiness, dry mouth
Beta adrenergic blockers o Metoprolol/atenolol/Carvedilol/Labetalol/Propranolol ▪ Ther use: HTN, Angina, heart failure, MI ▪ Complications: Bradycardia (monitor pulse), decreased cardiac output, hypotension, fatigue, erectile dysfunction, for propranolol – bronchoconstriction
Medications for Hypertensive Crisis o Nitroprusside ▪ Pharm action: rapid reduction of BP through direct vasodilation of arteries and veins ▪ Ther use: Hypertensive crisis ▪ Complications: hypotension, cyanide poisoning/thiocyanate toxicity – risk of cyanide poisoning is reduced by administering med for no longer than 3 days and at a rate of 5mg/kg/min or less (avoid prolonged use) ▪ Nursing admin: prepare med by adding diluent for IV infusion, note color of solution – if any other color than light brown discard, protect IV container and tubing from light, discard med after 24 hours, start at a low dose and go up every few minutes
o Prophylaxis of acute attack o Use the rapid acting nitrate at first sign of chest pain DO NOT WAIT UNTIL PAIN IS SEVERE o Take no more than 3 times but each time is 5 minutes apart if pain is persistent o Use prior to an activity that is known to cause chest pain o Place tablet under tongue and allow it to dissolve, store tablets in original bottles and in a cool/dark place. o Spray translingual spray against oral mucosa and do not inhale
- Topical ointment o Remove prior dose before new dose is applied. Measure specific dose with applicator paper and spread over 2- 3 inches of paper o Apply to a clean hairless area of the body and cover with clear plastic wrap o Follow same guidelines for site selection as for transdermal patch o Avoid touching ointment with hands Topic 23: Medications Affecting Cardiac Rhythm
- Antidysrhythmic Medications o Class I Meds: sodium channel blockers slow cardiac conduction velocity ▪ Class IA: Procainamide
- Pharm action: slow impulse conductions in the atria, ventricles, and His-Purkinje system
- Ther use: Supraventricular tachycardia (SVT), atrial flutter, A fib ▪ Class IB: Lidocaine (V Fib)
- Ther use: short term use only for ventricular dysrhythmias
- Complications: drowsiness, altered mental status, paresthesias, seizures (administer phenytoin to control seizure activity), respiratory arrest (had resuscitation equipment at bedside)
- Nursing admin: IV admin starts with a loading dose which is wt. based followed by maintenance dose of 1-4mg/min, adjust rate according to cardiac response, usually used for no more than 24 hours, never administer lidocaine prep that contains epinephrine
- severe HTN or dysrhythmias can occur o Class II Meds: Beta blockers prevent sympathetic nervous system stimulation of the heart ▪ Propranolol
- Ther use: A Fib, A flutter, paroxysmal SVT, HTN, angina
- Complications: hypotension, bradycardia, fatigue, bronchospasm in pt. with asthma
o Class III Meds: Potassium channel blockers prolong the action potential and refractory period of the cardiac cycle ▪ Amiodarone - Ther use: A Fib, recurrent ventricular fibrillation, recurrent ventricular tachycardia - Complications: pulmonary toxicity, sinus bradycardia, liver and thyroid dysfunction, GI disturbances o Class IV Meds: Calcium Channel blockers prolongs cardiac conduction, depresses depolarization and decreases oxygen demand of the heart ▪ Verapamil/Diltiazem - Complications: bradycardia, hypotension, heart failure Topic 24: Antilipemic Agents
HMG-CoA reductase inhibitors (statins) o Atorvastatin/Simvastatin ▪ Ther use: primary hypercholesterolemia, protection against MI, increasing levels of HDL ▪ Complications: Hepatotoxicity, muscle aches/pains (myopathy), rhabdomyolysis ▪ Nursing admin: admin lovastatin with evening meal, most cholesterol is synthesized during the night, monitor liver and kidney function
Cholesterol absorption inhibitors o Ezetimibe ▪ Pharm action: inhibits absorption of cholesterol secreted in the bile and from food ▪ Complications: hepatitis, myopathy (obtain baseline and monitor CK levels) ▪ Nursing admin: liver and kidney function tests
Bile-acid sequestrants o Colesevelam ▪ Pharm action: decrease in LDL cholesterol ▪ Complications: constipation (increase intake of fiber and oral fluids) ▪ Interactions: interfere with fat-soluble vitamins (A, D, E, K) and oral contraceptives ▪ Nursing admin: taken with food and 8oz of water
Nicotinic acid o Niacin ▪ Pharm action: decrease LDL cholesterol and triglyceride levels ▪ Complications: GI distress, facial flushing, hyperglycemia, hepatotoxicity
Fibrates o Gemfibrozil ▪ Pharm action: decrease triglyceride levels, increase HDL ▪ Complications: GI distress, gallstones, muscle tenderness/pain (myopathy), hepatotoxicity
Ther use: primary prevention of MI, prevent ischemic stroke
Complications: hemorrhagic stroke, tinnitus, hearing loss
Contraindications: Do not give to children or adolescents who have fever or recent chickenpox o Antiplatelet/ADP inhibitors ▪ Clopidogrel
Pharm action: inhibit platelet aggregation
Ther use: primary prevention of MI, prevent ischemic stroke
Complications: Bleeding, diarrhea, dyspepsia, pain
Thrombolytic Medications o Alteplase (tPA)/Retaplase ▪ Ther use: Tx acute MI/massive PE/ischemic stroke, restore potency to central IV catheters (tPA only) ▪ Complications: bleeding ▪ Contraindications: hemorrhagic stroke, active internal bleeding, severe HTN ▪ Nursing admin: best if used within 3 hours of onset, monitor H&H/CBC/aPTT/INR/PT /fibrinogen levels, limit venipunctures and hold pressure for up to 30 minutes on injection sites until oozing stops. Topic 26: Growth Factors
Erythropoietic Growth Factors o Epoetin Alfa ▪ Pharm action: increased production of RBCs ▪ Ther use: Anemia related to CKD/chem/HIV/AIDS ▪ Complications: HTN, risk of thrombotic event, DVT ▪ Nursing admin: monitor BP, do not agitate vial of medication, monitor iron levels and implement measures to ensure they are in the expected reference range, monitor H&H twice a week until target range reached ▪ Nursing effectiveness: effectiveness can be evidenced by Hgb level of 10- 11g/dL and max Hct of 33%
Leukopoietic Growth Factor o Filgrastim ▪ Pharm action: stimulates bone marrow to increase production of neutrophils ▪ Ther use: decreases risk of infection for pt. with neutropenia, cancer, and other conditions ▪ Complications: bone pain, leukocytosis, splenomegaly/risk of splenic rupture ▪ Nursing admin: do not agitate vial of medication, monitor CBC two times a week ▪ Nursing effectiveness: absence of infection, WBC and differential in the expected reference range.
Granulocyte-macrophage colony-stimulating factor o Sargramostim ▪ Nursing effectiveness: absence of infection, WBC and differential in the expected reference range.
Thrombopoietic Growth Factors o Oprelvekin ▪ Platelet count greater than 50, Topic 27: Blood and Blood Products
Whole Blood o Pharm action: increases circulating blood volume o Ther use: acute blood loss, volume expansion in dehydration/shock
Packed RBCs (PRBCs) o Ther use: anemia (Hgb 6-10g/dL)
Platelet concentrate o Ther use: Platelets indicated in thrombocytopenia
Fresh Frozen Plasma (FFP) o Ther use: replacement therapy for coagulation factors II, V, VII, IX, X, XI
Complications with blood products: o Acute hemolytic reaction ▪ Chills, fever, low back pain, tachycardia, tachypnea, hypotension ▪ Ensure client identity (using two nurses) and that Rh and ABO types are compatible ▪ Stop infusion immediately, keeping IV line open with 0% sodium chloride and new IV tubing o Febrile nonhemolytic reaction, fever, headache ▪ Febrile – most common (sudden chills), increase in temperature greater than 1 degree from baseline ▪ Administer acetaminophen for fever o Anaphylactic reactions o Mild allergic reactions (flushing, itching, urticaria) ▪ If occur – stop infusion immediately keeping IV line open with 0%NaCl ▪ If occur – if mild and no resp. compromise, antihistamines can be prescribed, and transfusion slowly restarted o Circulatory Overload ▪ Cough, SOB, crackles, HTN, tachycardia, distended neck vein ▪ If possible, wait two hours between units of blood when multiple units prescribed ▪ If occurs – stop transfusion place client in a sitting position with legs down
Nursing admin for blood products o Obtain baseline lab values: H&H, platelet, TP, albumin levels, PT, PTT, fibrinogen, K, pH, serum Ca
Pharmacology ATI Study Guide Copy
Course: Adult Health II (NR-325)
University: Chamberlain University
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