Transcript for:
Key Pharmacology Insights for NCLEX

foreign [Music] View Family it's Dr Sharon with Clinic reviews the very best NCLEX review in the country in my opinion so let's go ahead and keep going this is our pharmacology 4 video so we've done three previously I recommend going back and watching those if you haven't although you don't have to watch them in any particular order all right let's go ahead oh that's kind of small let's go ahead and look at these and I'm going to make this a little bit um different here okay you're caring for a client admitted with afib rvr which is rapid ventricular response they are on a continuous cardizem IV drip the technician shows you the following Rhythm okay so you have orders for all the following which is your priority intervention so here we have AFib rvr and cardizem if you don't know cardizem is the drug of choice primarily for afib especially with rvr because it slows down the heart rate and can even convert them back into sinus rhythm so when you hang up put them on a cartesm drip you're really watching to see if they're converting back into sinus rhythm and then once the cardizem that it it usually runs first like 24 hours something like that it may not be quite that long and then they put them take them back over and put them on PO cardizem okay so when you look at this the question is what is this is this still a fib is this something else so what we have here is if you look at it it is irregular now if you watch the previous video or if you've watched any of our EKG videos if you haven't go back and watch them because you'll understand this better having said that this rhythm is irregular the most common irregular rhythm is afib now how do I know for sure that it's afib well do you see how there's no distinct P wave there's just a bunch of squiggles along that Baseline there's no distinct P wave so when there's no distinct P wave but there is a narrow QRS and it's irregular this is a fib so we're still in afib but we're not rapid ventricular response anymore so it's really slowed down right so I don't think I don't know if this is a six second strip I don't know that it is but even if it isn't a six second strip I still know this is slower this this heart rate is definitely not your normal rate okay so having said that um I say well it's really slowed it down there's still an afib so you have orders for all the following which is your priority intervention so I can do any of these right so I've got orders say to titrate it up or down or to stop it and so forth okay so what do I want to do so I'm still in afib I've really slowed it down so do I want to take try titrate the cardism drip up which is going to slow it down more do you want to titrate the cardizem drip down which will speed it up a little bit do I want to administer atropine which is for symptomatic bradycardia or do I want to turn off the cardizem and start amiodarone so amiodone is for ventricular dysrhythmia so I'm crossing off number four I'm also going to cross off number one because I don't want to titrate the cardizem drip up because I'll just slow the heart rate down more so the question is do I want to titrate the cardizem drip down or do I need to give atropine well we don't give atropine it's we don't give atropine when the reason they're slow is because the card is up so we're not going to do that so we're going to titrate the cardizem drip down that is the correct answer you're discharging a patient with a new prescription for furosemide which of the following would you teach him before he is discharged select all that apply all right furosemide if you watched our pharmacology one video then you know this is a potassium wasting diuretic potassium wasting so knowing that I keep that in mind now I wanna I wanna look for the true statements because I'm not looking what needs further teaching I'm like what would I teach him before he's discharged so if I if I turn every one of these into a true false statement I'm going to pick the true statements if you struggle with SATA questions go watch our Saturday videos all right number one take this medication in the evening before going to bed well this is a diuretic so I'm going to say that's false because then they'll just be up all night go in the bathroom number two report to the health care provider If you experience increased fatigue or weight gain well I don't expect them to have increased fatigue or weight gains so definitely report that if they have it because they're like that's not expected so yeah definitely we're gonna true they do want to report that number three the healthcare provider May prescribe a potassium supplement for you well this is a potassium wasting diuretic it doesn't say they will prescribe a potassium supplement says they may prescribe a potassium supplement I like the word May and since it's potassium wasting I'm going to pick three that's a true statement you will need to have your blood drawn every week until the level of furosemide is stabilized in your body we don't check furosemide levels so that's false you will be able to stop taking the furosemide once the swelling in your ankles has improved well that's not typically how furosemide is ordered typically it's ordered because of an underlying disease it doesn't tell us they have an underlying disease but it doesn't tell us that they're taking it just because they have swelling in their ankles either so I'm not picking five that's not typically how we do that so the correct answers are to report to the healthcare provider If you experience increased fatigue or weight gain and the healthcare provider May prescribe potassium supplement for you so those are the correct answers okay so remember furosemide is a potassium wasting diuretic all right match the drug with its common side effects so one of the things a lot of times test takers stress over is how many side effects do I need to know well here's uh these are common side effects that I would recommend you knowing so ditch I think everybody knows what digoxin is it's an inotropic agent means it strengthens the heart fentanyl is for pain lithium we talked about that in the last video or maybe the second video I don't I think it might have been the second video lithium is an electrolyte that's used to treat bipolar Vancomycin is a an antibiotic for severe infections Methylprednisolone is a steroid adenosine adenosine is used to treat supraventricular tachycardia it slows the heart rate down Sertraline is an antidepressant and albuterol is a bronchodilator if you don't know those things you need to know what I just said so rewind this video and listen to what I said about each Med and write it down if you've taken notes write it down if you like typed up the list of meds remember the the list of 50 meds that's in the in the comments not the comment section but you know the the description of the video section those are the 50 meds you need to know so um if we're cut if though you find those 50 meds on that list and you write down the things I just said all right so let's talk about this so tachycardia what is a common side effect common side effect not adverse effect so out of all these drugs we know for sure that albuterol can cause tachycardia right all right how about bradycardia well we've got two options really I look at I look at digoxin and I look at fentanyl now you might say what about adenosine well we're not going to pick adenosine because um bradycardia is not actually the common side effect asystole is actually the common side effect of adenosine and by the way that is generalist knowledge every nurse knows that adenosine causes a systole a short few seconds of asystole before it turns goes back to sinus rhythm anyway so we've got digoxin and Fentanyl well which is more likely very very common to cause bradycardia well it's the digoxin okay digoxin is an inotropic agent but it also slows conduction through the AV node and it definitely slows heart rate red man syndrome red man syndrome is actually Vancomycin it's a side effect um as far I've never actually seen it happen but I guess it can cause some flushing in the face and all you have to do is slow down the Vancomycin so that's some facial flushing that can occur with Vancomycin you don't have to stop it you can just turn it down and then hyperglycemia I hope everybody knows steroids can cause hyper glycemia it's a side effect we don't necessarily have to stop the med for it but we do have to monitor it and then paresthesia paresthesia is the symptom that incurs with all electrolyte imbalances all electrolyte imbalances result in paresthesia and if the electrolyte imbalance doesn't even have to be that severe for paresthesia to occur so which of these drugs is actually an electrolyte well it's lithium okay so paresthesia is commonly associated with lithium now drowsiness so we've got left what do we have fentanyl well that's a pain med narcotic so it definitely could happen with that adenosine well that's for SVT probably not um search really and as an antidepressant so probably not so we're going to go with the fentanyl um and the reason I picked fentanyl for drowsiness over the bradycardia is because bradycardia is common with digoxin whereas drowsiness is common with fentanyl okay and then zerostomia if you don't know this word you have to know what the word means and it means dry mouth dry mouth y'all is the most common side effect of any psych drug any psych drug except lithium because lithium is an electrolyte so I'm talking about psych drugs like tranquilizers and antidepressants that's what I mean by psych drugs tranquilizers and antidepressants dry mouth is the most common symptom so definitely with sertraline and then a systole adenosine if you don't know this adenosine is given rapid rapid IV push and it causes asystole followed then by hopefully the sinus note picking back up and getting back into a sinus rhythm so if you don't know these things stop it rewind it or listen to this particular video several times well working on your med search floor you have a patient who's been seizing for eight minutes that is called status epilepticus if you don't know what that means so long long seizing status epilepticus is when someone's been seizing and don't seem to be coming out of it which of the following medications would you administer Lorazepam orally if any toe and rectally Lorazepam IV or phenytoin IV so they are seizing so we're not going to give anything orally so we're going to cross off the Lorazepam orally now the interesting thing is fenitoen is used to prevent seizures but not to treat seizures we don't get funny tone when someone is seizing so what we do is we give benzodiazepines benzodiazepines are the drug of choice for status epilepticus if you don't know it write it down keep track of it you need to know that benzodiazepines the pamel AMS Pam this ends in Pam Lorazepam so Lorazepam orally it's the right drug but it's the wrong route if any toen is the wrong Med Lorazepam IV is the right Med and the right route if anyone IP is the wrong Med so we use it we again we use those to prevent the fatty tolerance to prevent seizures not treat them all right one more which of the fine lab values indicates a toxic level of the drug now you don't have to know all toxic levels but you do have to know these four these are the four toxicity levels that you've got to know so here they are if you don't know them write it down lithium toxic is over two so that's the toxic level if any Towing toxic is over 20. digoxin toxic is over two and aminophen toxic is over 20. so lithium is the toxic level here all right Clinic reviews is working hard to update our reviews for next gen so just be aware that if you take a review with us it will be updated I will give you the specific dates for updates in another video as soon as Mark tells me that and so you can know that and go to clinicreviews.com to see when our upcoming reviews are we've got some exciting things coming out some changes coming to Clinic reviews with next gen so I hope you have a great rest of your day bye