all right guys hello so I'm going to record this video um to help uh review for the final exam for pharmacology this is going to be a very in-depth video because Mark Professor um didn't give us a good um review for the final so I'm going to take it upon my own hands and uh record this video for your guys's reference um just just so you guys are aware of I'm going to be going over 46 pages of our um of our study guide that we all collaborated together so feel free to pause um Along on this video for your guys's reference um just a quick review um just a quick uh notes um just know the one-third of the exam will cover exam two um a cover material after exam two and about two-thirds of the exam will be covered over um exam one and two so one third after exam two and two thirds over exam one and two other than that just know that I won't be going over too much in depth of the information um I'll just mention about the class of the drugs um and the drugs associated with that class as as well as the key things that I've highlighted me and Jay highlighted um in the slidey guide and it's going to be in depth so again please feel free to um pause um to your liking with that I will be going ahead and reviewing now so we're going to start with all the material covered after exam 2 then we're going to start with Central acting direct acting muscle relaxes so for the exam there's there's going to be a about six to eight questions dealing with this class of drug and we're going to start off with Central acting muscle relaxant so here are some examples of central acting skeletal muscle relaxant um backlin cyclobenzaprine carisoprodol and dipin the main medication um that is going to be important for the exam is going to be back llin and before I go over it let me go over U what this uh the class Central Central acting skeletal muscle relaxants are for so the difference between skeletal versus Central acting versus direct acting Central acting alleviates spicity all right and direct acting muscle relaxant um deals with muscle spasm cerebral pausy and spinal cord injuries all right um and yeah so we're going to go over right now Central acting skull to muscle relaxes the main one that we're going to be talking about is going to be backin this is the trade name but we're GNA I'll just say backin for now so um for backlin it's going to um it's going to help increase potassium permeability increased potassium causes decrease in muscle contraction the indications for this is going to be um muscle spe muscle spicity associated with uh multiple sclerosis muscle rigidity and spinal cord injuries um important things for this medication know about the adverse slash side effects uh to this medication so for backlin CNS depression dizziness constipation hypotension and urinary retention those are going to be the adverse side effects for this medication and aside from these adverse effects please know about the muscle the nursing considerations associated with backlin three things very important things you want to um you do not want to stop taking this med abruptly um you want to start at a low dose for this medication and gradually increase um this medication dosage and you want to take this on an empty stomach all right if you keep track of these three things um those are going to be uh very good for the exam exam worthy and again um I apologize for for um the different rainbow colors for throughout this uh final exam review um just know if it's blue that's very exam worthy um if it's going to be orange usually that's going to be the mode of action and usually if it's green that's very important information to keep in mind when you study but again yes for backlin know about the nursing considerations the CNS depression dizziness constipation hypothet and urinary detention here are other um um Central acting uh skeletal muscle relaxant cyclobenzaprine carisoprodol and dipan so review over that nothing too much to uh to focus on with these medications for dipen also known as valian um this medication is used for it is an it is an anxiety Med and has been shown to effectively to be effective as a central acting skeletal muscle relaxing so um if a question on the exam ask about the indication or let's say um the mode of action for dipan or Valiant it's going to help with anxiety that's the indication all right education uh what do you educate a patient on diazapam or Valley you want to do not stop taking the med even if you have drowsiness as it has a rebound effect so remember tell your patient not to stop taking the medication if even if this person is feeling drowsy you want to continue it or else the effects of it will decrease all right so that's going to be Central acting skeletal muscle relaxing now we're going to go to the other category other class and that's going to be dealing with directly acting skeletal muscle relaxin so here are here are the couple medications associated with this class dantrolene and Botox um the main thing for the exam I want you to know for is going to be um dentaline dentaline will be focused for the exam so please um review over this um to your um preference so the first medication for D direct acting will be dentaline duline is going to be very important as it uh as it is indicated for someone who has experienced a malignant hypothermia um in other words severe um high temperature severe hyper severe fever basically um for um for indications for duline I already mentioned malignant hypothermia and that's basically characterized by fever muscle rigidity and tachicardia um but also be aware that this could be all the apply just so you know so malignant hyper muscle spasms multiple sclerosis and cerebral pausing remember this is direct directly acting skeletal muscle so this one is going to this is going to be dealing with muscle spasms muscle spasms associated with these types of conditions so if you want if you want a good way to think about the indications muscle spasms associated with MCM MCM man crush Monday but you but in this case it's multiple sclerosis cerebral paly and malignant hypothermia um there's going to be a medication associated with malignant hypothermia and we're going to go onto that in a little bit but um just be aware that's what we're going to talk about adverse effects for dine weakness drowsiness dizziness and hepatotoxicity remember if you're going to have a muscle relaxing you're going to be relaxing if a person is relaxing how how are they going to feel they're going to feel weak they're going to feel drowsy they're going to feel dizzy and remember hpal toxicity so hpal toxicity wlabs you look at your alt and a all right all right uh yes and there's going to be this is going to be a little bit confusing but patients with multiple sclerosis and curosis um remember dentaline is for muscle spasms associated with the condition not the condition itself so keep that in mind so because that's going to be very important if they have muscle spasms and they have multiple sclerosis then that's going to be um that's going to be the cocktail for for this medication all right boto talk don't worry too much about it but just know that it's going to be one of the direct acting skeletal muscle relaxes and that's going to be important because I think for for considering I've taken this exam um um it's important to know the medication and what class does it fall under it could be a drop- down selection question so keep that in mind now so that's about so remember so Central acting and direct acting muscle relaxant it's about six to eight questions if you know about um the class the class and medication one right two three 4 five let me see five and let's see basically five six six seven and eight so basically know about those things in green because those are about six to eight questions that could be potential for for um the fing s for Central acting direct acting muscle vacines with that being said we can go further with the next uh class of Ned and that will be on uh General and local anesthetic agents so about three to five questions are associated with this class of medications so we're going to talk about different concepts that are potential for this so um when we talk about General and local anesthetic agents you want to start on the basis so we want to know about the concept of balanced anesthesia what is balanced anesthesia and how would you describe it as use so balance anesthesia is the use of multiple drugs that act in different ways to help prevent toxicity and adverse effects so the more the better to prevent toxicity and adverse effects all right does it associate with all medications no only certain medications and these are examples of certain medications that could have this balanced anesthesia effect barbituates non barbits nitrous oxide and volatile Ms Right remember this one this one is um correlated with um certain medications not all medications all right now let's go over general anesthesia so for General anes athesia there are going to be different stages and phases to be aware of okay so let's go over so for the stages of general anesthesia there's going to be four stages in reality there's three all right I want you to focus on the first three rather than the stage four right stage one is the induction phase induction phase it is the loss of pain sensation stage two this is the com uh combative excitement this is the danger period This is where uh sympathetic stimulation occurs when you think of sympathetic stimulation you want to think of your sympathetic nervous system everything is going up your blood pressure is going up your heart rate is going up that's how it that's the danger period okay that's stage two general anesthesia now stage three is the maintenance stage the maintenance stage deals with relaxation of skeletal muscles loss of reflexes and pupil dilation so this is when things start to die down all right on once things start to die down that's when there's another danger period that you might see and the actual die down is going to die the severe CNS depression once all once basically your CNS is depressed severely they're going to be brain dead so this is something to keep in mind so that's why there's in reality there's really three stages because the fourth stage is going to be bre death basically so keep in mind about those four stages and what um those three four stages and um what are they talking about in that stage now these stages um are correlated with the phases and we already talked about um each phases with this one so induction phase induction phase deals with stage one and stage two the maintenance stage only stage stage three recovery um that's usually associated um with any it can be in between right um this is the recovery if they're going to be U actually going to going to when the body attempts to go back into uh homeostasis or into recovery right um this is not going to be occurring during the stage of four uh stage four because basically this is death brain death basically so just know stage one and two induction uh induction stage stage three is maintenance stage and hopefully hopefully after that it should be recovering at that point so those are the general concepts for general anesthesia and local anesthesia now let's get into the medications and I've already highlighted on the medications for this that are very important for the exam so we're going to start off with the general anesthetics General anesthetics this is going to be your your benzo dipin an example of an Med that is an example of this class is medasin medam or the trade name ver said this is going to cause rapid onset and amnesia for your patient this is going to be very H this is going to also cause hypnosis and it is also a sedative all right these are the three three types uh or three adverse effects I would um focus on for your exam so remember for your here's a trick for your adverse effects make sure to know at least five uh five ad effects at a minimum at least three and that's going to help you with your select all that apply right so you that kind of eliminates your overthinking second guessing during the exam all right so no about three to five especially these three now your top local anesthetic this is your lidocain lidocaine lnl okay um an indication for this excuse me about to sneeze um an indication for lidocain other than an anti rythmic is also going to be a local anesthetic as an anesthetic a local anesthetic the indication for this is going to be used for infiltration so water are some signs and symptoms of of an IV infiltration remember if the person is if the person's IV site is emitus if there's edema if there's tot skin if there's cooling at the skin those are signs of infiltration and that's what lidocaine could be used for this is used for infiltration and also for peripheral and sympathetic nerve blocks spinal Central and codal anesthesia also um for adverse effects for lidocain remember L and L and L so lidocaine local anesthesia also with local reactions I like to say local hips for your adverse effects local hips hips hypotension incontinence perius and seizures those are going to be your main a effects dealing with lioc and remember General anesthetics and local anesthesia those are going to be your main medications to FOC focus on okay and let's see how many questions oh we're not even done with oh yeah so know about that one two three four five all about those so know about those things that that I've talked about um previously and that's for General local anesthesia now we're going to go into neuromuscular uh Junction blocking agents um um just know there for these agents there are two types of Agents depolarizing agents and non depolarizing agents depolarizing agents are going to be your Agonist to um to AC all right and non- depolarizing agents are going to be your antagonist to AC all right for these medications I really want to spe uh focus on your depolarizing agents um for your depolarizing agents really just focus on what Med and what um class ofet is it really um tied into rather than all the special adverse effects and me mechanism of action let's really focus on um the medication and the class 4 non-polarizing agent because remember there's only two to three questions the main thing is going to be dealing with the depolarizing agent and that's going to be your s cocoline all right your high alert so your suine is going to be your depolarizing agent and the the big things is going to be your indication your adverse effects and yeah and the signs and symptoms of that adress effect so we're gonna break it down so the indication for your depolarizing agent for suino choline um is going to be suino choline is going to your uh uh your medication that's going to paralyze your patient it's a paralytic engine all right your depolarizing uh paralytic agent all right that's going to paralyze your patient prior to prior to or before intubation all right so endot tracheal tube can be inserted remember for intu uh for this medication this must support ventilations and also used for intubations all right so keep that in mind before intubation there must be support for ventilations and again it's used for incubation for this medication this one the onset usually lasts five to seven minutes so keep that in mind for the examle all right for your adverse effects really just focus on there on three of the adverse effects um because there's going to be a lot the main thing for this medication is going to be your hyperemia your high potassium levels your muscle pain and the big adverse effects malignant hypothermia which we'll be talking about afterwards um your Contra indications for for the S suino choline medication is going to be your uh prolong apnea so trouble breathing hyperemia which is your High um uh high potassium levels major traumas and narrow angle glaucoma right so if the person has this don't give it to um the patient right now other than the Contra indications uh let's go back and talk about malignant hypothermia and what did we say about malignant hypothermia hypothermia hyper High thermia the temperature so malignant very very bad so very bad high temperature of the patient and remember so for malignant hypothermia we are going to use a medication that's going to treat that specific condition and that medication is naturally so once so let's connect everything together so if you have a Medicaid if a person is u a doctor orders suino cholon as the medication for ination intubation for for a patient um you're going to also have the medication of dant suino Coline and duline go together because of the risk of malignant hypothermia okay so again muscle of malignant hypothermia there's going to be different signs and symptoms again increased temperature uh muscle rigidity all right um you want the O2 at 100% or the risk of having trouble breathing um nursing intervention so if a person this could be a exam question so I just want you to let you know um if you have a person whose temperature is at 101.4 all right so that's going to be a very high high temperature right what is going to be what is going to be your priority priority nursing intervention remember the first one is going to be checking the vital signs of patient stopping the medication the sucky sucky medication initiate cooling measures when you meant when we're talking about cooling measure that means your cooling blanket right lowering the temperature of the room right administering dentally for the for the malignant hypothermia and assessing respiratory status right remember number one thing the number one priority if a person has malignant hypothermia malignant hypothermia you want to check the vitals before you stop the medication uh initiate cooling measures administer duline and assessing the respiratory status okay that's going to be very and that's going to be for sucal cooling now your non- depolarizing agent like I said um examples would be your penum your atra curium your cisra it's all these medications cuum Med medications um this is going to induce skeletal muscle relaxation reducing the intensity of muscle contractions in Electro convulsive in in electr compulsive interventions I guess and facilitates gas uh facilitates care of mechanical ventilation patients all right that's going to be the mode of action um but um you don't have to focus too much about uh this medication or these medications focus on um penarium as a non basing antagonist okay and if you're having trouble at panum is not on the exam at least know that anything that ends with curium or neon or curum curium cuum those are going to be your non-polarizing agents whereas suino choline is going to be used as your depolarizing agent all right and that's going to be your neural neurom muscular Junction blocking agents remember there's about two to three questions for the exam and most of those questions are going to be focusing on suino choline and malignant hypothermia so keep that in mind who's this Jay hi Jay all right so now we're going into drugs acting on the upper respiratory track so for the for the upper respiratory medications there's about eight six to eight uh questions on the exam right so I'm going to go in depth a little bit with each Med that's going to be very important all right the first met type of Med is going to be anti-us of medications anti-us of meds the M the main highlight medication is going to be dextorin or retusin I'm gonna unbold this one because this this medication is gonna be very important for anti-ps I want you to know I want you to know two things the drug the drug to drug interaction um and the nursing interventions with u with associated with um antibes now for anti-us this is going to be it's going to depress the cough set Center in the medulla to control cough spasms remember for ENT tubs this controls and reduces nonproductive cough nonproductive cough and I think I should be doing this one I should be highlighting this and underlighting this because it's very important anti cements are dealing with nonproductive cops right now um other than all the adous effects of course it's going to cause drowsiness and sedation and the drawing effect on the mucous membranes but I really want you to know about the drug to drug interactions and nursing interventions so let's talk about so you you try not to combine um anti-s with maois such as phenoline phenoline the reason why because of this it's going to cause hypotension fever nausea myoclonic jerks and coma all right so maois with dextrorphan may cause hypertension fever nausea myoclonic DS and also coma so keep that in mind now your nursing intervention for anti-s remember this medication your anti- Mets are going to be best used with patients with a dry irritating cough dry irritating cough nonproductive cough keep that in mind and remember antitussives it starts with an a it's going to be abusive doesn't apply to all medications obviously but just keep in mind that to um address this in your patient education when teaching about this now we're going to go into topical nasal decongestants aphron and syx oxymetazoline I apologize for the mispronunciation um for this medication for this class of medication I want you to focus on the adverse effects and the nursing interventions for this medication now with with the top need of decongestant are oxymetazoline um know that the adverse effects will include rebound congestion and muc mucosal ulcerations remember um rebound congestion is caused by overuse of nasal sprays so remember don't overuse nasal sprays use it only um in the nursing use it do not use it greater than 5 to S because it can cause rebound ingestion okay overuse can cause this condition um also long-term use can also lead to mucosal ulcerations right so keep that in mind so again nursing interventions do not use it greater than five to seven days because the patient may have rebound congestion if used longer than that the nasal passage to become congested as the drug wears off thus initiating cycle of congestion so remember don't use it too long only try to use it only five to seven days a week Max okay now let me get a breather real quick so now oral de congestant so there's going to be a couple meds um not too much so there's pseudo epidrin and phenol ephrine those are going to be your medications that are going to be associated with oral decongestion the main thing about this is that patients with high blood pressure should take the over-the-counter coradin Beno ephrine it is a combination medication drug so keep that in mind okay we're going into going into this now so topical nasal steroid decongestion um this is going to be um again we talk about nasal yeah basically we talked about it again so remember long-term use can lead to mucosal ulcerations dryness of the mucosa suppression of um healing so basically this is basically repetitive redundant between this so keep that in mind [Music] um also I want you to know I think I didn't add this before but I want to talk about this s so what is this the okay so decongestion should be avoided with patients with these types of conditions and or um conditions so category cens hypertension uh coronary artery disease hyperthyroidism diabetes mtis prostate enlargement and glaucoma this is going to be contraindications with the congestions so keep that in now we're going into first first generation second generation antihistamines now it looks intimidating at first but trust me it's not that complicated all right um basically for anti-histamines basically it selectively blocks the effects of histamine at histamine one receptor sites decreasing the allergic response they also have anti-colon energic effects um and anti- peridic effects so anti-cholinergic anti- drying right so it's like a anti you know anticholinergic so drying effect and also anti- peridic peridic is itching anti you know anti- itching effects some itching effects and all that all right let me see let me see I want you to know the adverse effects for first generation antihistamines such as drowsiness and sedation and anticolic effects in cardiac arhythmia remember if you're remember there's a lot there's going to be a couple meds that will have cardiac arhythmia so if you're taking an antihistamine okay and the adverse effect is going to be cardiac arhythmia if the person experiences a high heart rate what you're going to do as the patient you're going to check the April pulse for full 60 seconds okay keep that in mind drowsiness because the medication crosses the blood brain barrier and sedation anticholinergic effect so this is your drying effects and yeah we talked about that now I want you to know that um there could be a question on the exam about um children with um taking antihistamine so benad right um what are what is going to be your education to the parent with children who's taking benad when before they're going to travel right you want the child to try the medication at home before traveling uh try it at home to observe the effects because there's going to be an excis excitatory response right have they have a greater anticolon energic effects with drowsiness manil can also be used as a restraints to due to that so know about that specific effect and know about those specific details remember benad dril and uh D and hydramine are interchangeable one is the trade name and this is going to be your generic name now your second generation antihistamine same uh uh mechanism of action um but the main thing for the main difference between the first and second generation is going to be um the side effects second generation antihistamines such as morati they have fewer side effects than first generation number one is that always number one so always make sure of that so vity has fewer side effects than dapen hydramine also known as benad so second second first the worst second best you can think about that way all right and we talked about that patients that needs patient that needs to be alerted should take second gen because it's less seded there you go remember so think about it second the best so second Generations are going to be your first line treatment Mak it then first your first generation is going to be B all right your expector so when you're thinking about expectance you want to cough up the secretions that's going to be that's if the patients have difficulty coughing up the secretions we're going to give this Mucinex and guine that's going to be interchangeable over the counter drugs all the counter cold products also contain guine all right so keep that in mind conditions where in expectr such as Mucinex would be better than an anti-us if the person has rhinosinusitis chronic bronchitis of the respiratory infections and mo so keep that mucs acetal cysteine so acetal cysteine is going to break down the mucus at to high risk patients in coughing up thi secretions right remember keep in mind of that usually give this through a nebulizer or an endot tral tube and I want you to know this specific uh usage for aceto syy it's used to treat acetam menine overdose and acute renal failure all right so keep in mind of those things one two three four there's going to be a few medications that I've T I already talked about 16 questions about here so those are all fair game for the exam so keep that in mind all right did I talk about this no so now we're going to be going into the lower respiratory Um Kingdom so there's about six to nine questions regarding lower respiratory so looks like there's going to be a lot of these questions so no about lower respiratory okay so let's talk about before we go into the men let's talk about the specific path path pathophysiology of different conditions dealing with lower respiratory trck and that's going to be dealing with asthma COPD and your Arts remember so if you're just looking at this remember with asthma there's going to be your Bronco constriction your COPD that's going to be branched off well your COPD is going to be your umbrella ter for two conditions chronic bronchitis and EMP all right one will be dealing with too much muc mucosa um mucus production in the throat and another one will be your your enlargement of those airs spaces right those damage with the the Alvi so keep that in mind and now with ARs remember it's characterized um uh dealing with the um AC acute lung injury Ali and your alvolo cap capillary membrane so keep it keep that in mind so again basically what I reviewed over that back in patha um your asthma is the narrowing or the the constriction of the airway iges that's going to be your mass cells that's going to be associated with asthma all right and usually with Mass cell stabilizers you want to give that 15 minutes before exercise okay COPD we talked about this usually there's a chronic exposure to irritance that cause a chronic inflammation and swallowing in the airway especially with your um an example of this kinds of irritance would be um smoking right your smokers are going to be highrisk people for COPD all right and um a technique if a person does have COPD one technique you want to uh teach them is going to be the the pur lip the pur lip technique basically that's going to help push out that CO2 all right now chronic bronchitis chronic bronchitis is going to be again like I mentioned there's going to be a lot of mucus production in your throat um caused by too much smoking or a different genetic condition uh it's the inflammation of the bronchial tubes that is defined by a productive cough at least three months out of the year for two for at least two years so remember three for two three tacos for2 so keep that in mind empyema defined by structural changes leading to enlargement of the air spaces can cause pneumonia um for you want to give vassel dilators to open up your lungs of dealing with structural change so keep in mind you can give vessel dilators and Thea that's very recommended remember COPD can cause right-sided heart failure so make sure you give your patient your anti-hypertensives your ACE inhibitors your arbs and your beta blockers okay or or your beta blockers ACE inhibitors or arbs or your beta blockers so keep that in mind if there's obstruction of the air airway with mucus and remember this is you're going to see this very significant with chronic bronchitis you want to give mucolytics and what is mucolytics going to do it's going to dry up that cough right so let me let me go back so I'm not giving you false information so let me go back here where am I yes so we talked about it's over lord where is it passings and why didn't I put this this should be highlighted so let me see three very good I don't know why it's not on there so remember this is going to help break down that mucus in coughing up th secretions so that's going to be good with C okay okay let's see let's see very good an ARS is characterized by acute lung injury and inflammation to the alvow capillary men so remember l l Arts so acute lung injury inflammation to alvolo capillary membrane signs and symptoms for these conditions so COPD of course you're going to see some coughing some cyanosis excessive mucus secretion so again with this give mucolytics um quiet chest dis penia and build up the co CO2 for chronic bronchitis you're going to see your overweight patients your CTIC patients your elevated hemoglobin right older and thin this is going to be all your signs and symptoms associated with the condition so please keep in mind about that for the examp just in case um bian gives out questions related to pysiology hopefully isn't too much and this is um so this is just for reference feel free to pause whenever um this is basically describing the patho of uh of COPD right there's air trapping involved right and all that I'll put that for your reference you've probably seen it already so keep that in mind now we're going into um the medications dealing with the lower respiratory um right so there's we're gonna talk about epinephrine first right epinephrine that's going to be your ba epinephrine is going to be your beta one and two Agonist it's going to be your Sy sympathomimetic aent and your rescue inment so there's three kind of categories that fall that epinephrine falls under it has three rules and that's the one I just talked about um there's different indications and uh usage for epinephrine it can treat anaphylactic reactions right and your acute asthmatic attacks it treats acute asmatic attacks that cause M constriction so keep that in mind okay nursing intervention nursing interventions it increases heart rate and blood pressure can cause nervousness anxiety causes palpitations and an and ah can speak can cause arthas so basically what are you seeing with this medication your sympathetic nervous system caus that everything's going up so keep that in mind uh you don't have to worry about this and this it's fine now we're going into albuterol so albuterol or another medication associated with this this hydroid so it's going to be Albuterol and aromal so basically this is going to be your beta 2 adrenergic Agonist sympath and rescue inhalers so what did we say so Albuterol and your epinephrine are going to be rescue inhalers all right now with albuterol one of the effects that are is very important other than respiratory um is going to be your cardia the adverse effect the main adverse effect for albuterol is going to be cardiac arithmos and that's and remember again with the nursing interventions is going to cause that increased heart rate and blood pressure you want to monitor you want to monitor your um your apical pulse for a full 60 seconds and you know know all your blood pressure and your heart rate you want to you want to monitor that because that's very important all right again these are your rescu inhalers epinephrine and albuterol both of them cause agitation and Tremors and tachicardia they're used in initial attacks and and they are fast acting they can also be used for daily maintenance so keep that in mind um I put this medication I didn't describe it very well but um I don't have any description for this but just know that uh for motero could be a long Act is a long acting beta 2 adrenergic Agonist this could be an exam could be not but I just want you to correlate the med with the class of drug now we're going into methyl zantin so me methyl zantin there's aminofilin there's keine and theop filines focus on the thop filings okay remember what's going to be the number one assessment for someone who's taking a methyl xanthine that's going to be smoking smoking usage because smoking can cause drugs to be less effective and toxic leading to cardiac problems so it's always what you want to ask the patient um do they have a history of smoking or do they smoke because that's going to be important if they do smoke you want to increase the dosage if necessary if necessary okay now we're going into anticola nergic uh drugs right your epot tropanes medic for this class of medications oh Lord okay here we go so let me yeah I'll put this Troian this is gonna be your second line after rest yes remember osion is going to be your steroid there's going to also be steroids okay so keep that in mind um when you have anticholinergics this is the things that you can't this is going to things that these are the adverse effects that are going to show the person has anticolic of the person can't poop right they can't poop they can't pee so when you see when you think of a person not peeing the person is going to be urinary retentive urinary retentive they can't spit so they have no cough no cough production and they can't see with not thing so keep that in mind all right conscious indications for uh consci indications and precautions with this class so no uh pregnancy lactation no no no remember anticolic are not used for emergency situations like an acute attack or a status asthmaticus right you want to be cautionary with acute Broncos spasm ladder obstruction prostatic hypertrophy gloma and and peanut allergies all right all right so nursing interventions I think we already I think it was already copy and paste here but acute bronos spasm bladder neck obstruction or prostatic hypertrophy make sure you you assess your orientation a the aect and the reflexes of your patient what just some teaching points about this medication these have less cardiac effects then alal but the key thing for this this is the second line after the rescue drug right it's not it's not the first line just because they have less AR card uh effects just know that this is going to be later on okay inhale glucal cord quits um an example for this will be your budson I want you to keep in mind about this medications because this is very important so for this medication you can administer this through an inhaler usually it can give it through a pill and a nasal spit the adver the adverse effects associated with Bud cide include decrease healing headaches rebound congestion epistaxis oral citis causes a sore throat or Force voice R epist Stax is basically your nose bleeding right nose bleeding so keep that in mind um um all right I want you to focus on the nurs and considerations all right um usually if a person is giving um has um is prescribed this this is something you have to know okay usually you give your bugs anide after your albuterol right albuterol first which opens up your Airways it does not help with bre opens up your Airways opens up relaxing opens up that muscles four Airways okay Abal first you wait two minutes and you take your butts in night okay so keep that in mind appal first wait two minutes you take your butts and L okay these are the steps of using aner right you want to shake your inhaler first exhale then put it in the mouth inhale the medication hold for 10 seconds then rinse off and remember to taper off the drug and it's used to for long-term use for long term due to taking a long time to getting into therapeutic range so keep that in mind rinse your mouth and remember to rinse your mouth after you inhale right to reduce the risk of oral can uh thetis can candid diasis so keep that in mind okay I'm gonna highlight this keep that in mind those are the nursing interventions are going to be your nursing interventions and your aders effects are going to be important for this medication am I still on the screen recording yes I'm still on all right so let me get a drink of water I'm parched okay now you're in inhaled cord steroids all right inhal corticoids and also as well as GL corticoids they're not used on an emergency basis so you want to use those rescue inhaler of your rescue drugs first like your Al uteral and your epinephrine first all right so keep that in mind now the last uh the last class that is new for um after exam two is going to be your lucat treine receptor antagonist remember um this is going to be your seir clast and your monast right remember for this do not take your aspirin remember drug drug to drug interactions amop filines and your warrin okay there's going to be many drug to drug interactions so usually this class is not usually preferred but this is the mode of action for this for this class it's going to block receptors for lucat Tre reduces inflammation Bronco constriction Airway edema and mucus reduction this is going to be your last resort your last Last Resort all right so remember keep in mind about uh your lower respiratory medications because that's about six to nine questions more than your upper respiratory medications which are about uh about 68 question one one uh one question above but still focus on these respiratory medications so those medic that I've just covered are all material after all right now I'm going to go over Concepts relating to uh medications that are um that are going to be there going to be a review from exam one and exam two so bear with me I'm only going to be covering things that are really important and the blue blue highlighted ones so keep that in mind okay okay okay so the first uh first class is going to be anti-inflammatory there's about three to five questions for anti-inflammatories remember the adverse effects the main adverse adverse effects is going to be GI bleeding right assessments liver function is going to be important due to the risk of this GI bleeding so what are you going to be looking at what kind of labs are you going to look for with the anti-inflammatory your alt and a you want to make sure you want to give with you want to give um you want to give food with this medication okay monitor lab results related to the blood cles okay aspirin remember with Aspirin you want to the adverse effect for aspirin is going to be ttis and your GI bleed right overdose with Aspen can lead to acidosis right so keep that in mind um um excuse me also with Aspirin you want to evaluate CNS status so monitoring your locc your um level of uh Consciousness your orientation your reflexes your eighth cranial nerve function why the eighth cranial nerve right remember the eighth cran nerve from Health assessment it deals with hearing hearing right so that's why uh with tonight is that's going to be correlated with that so keep that in mind and your affect right to assess the NS effects of the drug so keep that in mind if a patient reports dizziness mental confusion difficulty hearing also termitis then assess for the patient of the use for the use of solides right so keep that in mind um yeah very good um Le check your CNS tinny and bleeding remember it can cause bleeding tentis and you want to check for CS all right aom menine analgesic antipyretics this is your category B drugs so category B um this is like you know kind of safe for your repr right or is it see yeah get that um for aceto menine your he hypo Al he that's for your hpat toxicity your liver toxicity so know about your alt that's going to be very important hypo what is that correlated with your mode of action it acts directly on the hypothalamus to cause fossil dilation and sweating which helps reduces beever all right so keep that in mind your ibuprofen ibuprofen okay so it's gonna inhibit poed synthesis blocking Cox one and Cox 2 um know that it's going to be the first line treatment for rheumatoid arthritis your ioen right first line treatment for arumat arthritis it's be ioen right Al my arthritis yes so know about that so keep that in mind um your curac uh is basically it's an anti-inflammatory analgesic anti piratic and said the main thing for karac not really focused but I just want to mention just in case this is shortterm p right short-term pain relief and remember just in case she mentions it again for the final exam there was the story about Helen hasy and her son Lewis about how Lewis died tlac because the nurse gave the long doses to a child whereas the nurse gave the dosage of um what you call it the the adult so keep in mind ctor laak is short-term painting may cause peptic ulcers and real injury and that's how Le died so keep that in mind um your second treatment for rheumatoid arthritis is your aopen aopen is gonna be your second line treatment for rheumato arthritis remember first line treatment is going to be your I um remember your adverse effects your adverse effects to a raw nothing it's going to be your bone marrow suppression your renal toxicity GI adverse effects and your rabdo myis so those are going to be your adverse effects um and I highlighted that that's very important okay exam worthy so and this is going to be your the next the last medication for I think anti is going to be your Tanner sub your ETA ETA ETA your ETA is going to be infection very severe right all right now I think that's going to be your that's going to be the key things for anti-inflammatories keep in that so keep that in mind next is going to be your your principles for opioids and narcotics the main thing for opioids and narcotics is going to be your respiratory depression respiratory depression it's going to be very important for your um your narcotics the person can die if they're not breathing right so that's going to be that's going to be very important for Narcotics now for narcotic agents there um I really want to focus on morphine it's the main medication for for narcotic Agonist and ADV effects to Morphine includes respiratory depression and urinary retention so give that a mind all right this acts on the Mu Delta Kappa receptor right the main thing I want you to know what's the antidote with what's the antidote if if a nurse accidentally gives morphine to much morphine overdose the loone Nar those that's going to be your antidote for morphine or overdose right always keep nocko in handy um keep patches and suckers Out Of Reach of children um administer medication when virals are within normal limits normal limits meaning if if um if the respiration is U is around 10 or 10 or six don't give morphine that's just stupid you want to give it when it's within normal limits okay um safety considerations with with narcotic Agonist lower the bed to the lowest position give the your patient colly right you know this all right this is going to be your butor this is your both narcotic Agonist and antagonist this is both so keep that in mind um M withdrawal symptoms in opioid o users such as sweating nausea vomiting and tachicardia so please keep that in mind um oty pregnant the reason why OT pregnant pregnancy is going to be your conscious indication so don't take it if you're pregnant um of obviously watch out for your alt a um with this medication okay okay all right um remember um for for migraines sumat tripin is going to be preferred over OTS right pregnancy usually last resort um Suma with the sumo it's very good big very good so Su is preferred over ergots because OTS has more adverse effects compared to Suma tripin so keep that in mind the Contra indications for Suma make sure um you don't give it if if the patient has had a recent heart attack on M A tanp is a topical for uh remid arthritis the tanp it's far away we've talked about that before before um principles of anti-infective so for 5 take questions about this so about the same amount of questions for your upper respiratory MTH so your antibiotics are going to be your very your your ORD medication cost as well compared to your upper respiratory okay so remember if some if someone is on an antibiotic remember you want to take an on on an empty stomach complete the full course of the prescription even if they're feeling better and remember to educate that it may suppress the effect effectiveness of birth control pills your birth control pills okay now the difference between broads Spectrum versus narrow Spectrum antibiotics right so broadspectrum acts against a larger group of bacterial types that can be used to treat a variety of infectious diseases and Naros Spectrum usually acts on a limited uh group of bacterial uh types very selective so what what type of antibiotics do you usually give first if you don't know um a specific infection so you this is what you're going to do you're U you don't know that the specific infection you want to give the patient a broad spection antibiotic okay your broadspectrum antibiotic then you would order a culture and a culture a cultures culture test right to identify the specific infection spec the specific um bacteria or yes the specific infection bacteria causing that infection right and once you get that that specific bacteria or the microorganism the micros all that then you would give then um once the test is over and there's a specific result then you would give your n narrow Spectrum so it's broad to narrow if that makes sense I apologize if it do um discuss why we why we have resistance strange of uh strains of microorganisms and name three ways to minimize resistance to minimize resistance of microorganisms you want to finish your prescription use only as needed and to minimize resistance you want to have broad spectrum right Broad broad spectrum all that's going to be your first line first line for antibiotics broad spectrum and your spectrum now we're going into antibiotics then the line of so these are going to be your spilos SPS are going to be your betal lact right these can treat your menitis right keep in keep in mind that fluoroquinolones or cylux and your level fline adverse effects is going to be your Achilles tendon rupture so keep that in mind your amoxicillin reactives augmenting penicilin um amoxicillin can cause class one allergic response um such as rashes and trunk right so such as rashes and difficulty breathing okay there solomides solomides I went over this medication for my for Fest um especially for coim moxo kosim moxo um is going to be sulfonamides so one of the ADV effects that are going to be important to keep in mind it's going to be sunburn please uh try try your best to identify the difference between a sunburn and um and red man syndrome a lot of people got that mix mied up on previous exams um remember if there's a bra strap this is how I got it for the fs or for for the first exam if there's a bra strap and there's red the redness of the skin that's going to be usually a sunburn a good indication if the person has a sunburn but if the person has a really red skin all over no bra straps or nothing that's going to be a red man syndrome and we're goingon to talk about red man syndrome later okay but the main thing I want you to focus on for adverse effects with solomides it's going to be your sun all right all right um and have the person protect the skin from the Sun please and drink fluids to prevent irritations from Ur crystals your tetracyclines teeth for teeth so um tetracyclines affects the teeth and the bones by impairing mineralization of right um Contra indications don't give it if the if the person is pregnant or is lactating or if they're a kid right these already you know sad things are so don't give it if this happens lactation and renal and hepatic dysfunction so monitor your aot ASD main thing please thank you why did I hold that now for your Mac lights this was on a previous example so pleas on please know this P so ay and clery um your reth M your Maids your maides um Can prolong your QT interval and cause EKG changes which may result in chest pain and lethal arhythmia so keep that in mind uh Venoy veny glycopeptides uh um so yeah Bal flushing remember red man syndrome red man syndrome usually occurs with bin you want to run the bomy for at least an hour before anything less will CA anything less will cause Rand syndrome okay adverse effects for bomy facial flushing hypertension fever chills why is this adverse put that over here okay um if the patient shows signs and symptoms stop the medication first before call me the doctor please thank you all right so that's going to be I think went over antibiotics this already talked about um explain selected toxicity it in selected toxicity injures the target s but not the host we talked about this take antibiotics on an empty stomach complete the full course of prescription and just know that it may suppress effess effectiveness of birth control pills we went over these two things already we talked about this um and these are the three common adverse effects to antibiotics remember kidney damage renal GI tract toxicity and neural toxicity so so basically what's the main thing assessor CNS get your butt and Crea levels GI toxicity like those are going to be your three common average effects for antibiotics a nurse is planning to give Genty to an old client what lab value will be most important to review during the assessment based CA all right we're GNA go into the realm of antivirals there's about two questions on this so I'll try to make it a good review so CD4 count that's going to be the lab values usually associated with virus CD4 count is the normal range is between 500 to 1,200 right remember the higher the better if there's an increase in CD4 count the drug is working right so keep that in mind so there's a couple drugs that are associated with um with this uh with this class right the main important thing I want you to know because a lot of students got got it confused for for the first exam and people challenge some of the questions but um to the professor but um she's not going to challenge unfortunately um I want you I want you to correlate class or the the usage for antivirals know about the indication and what Med do you get so ranad ranine is going to be for influenza A and respiratory uh finus right REM Des ofe that's for covid-19 it cuts down from 15 days to 11 days right herpes and an agent for uh CMV why is that okay there um AO anir anir is heepsy influenza A Radine an anir heepsy aoir herpes okay so keep that in mind heppy again and tiir is for uh hepy so if you think about an influenza A it's going to be your ranine Hepatitis B is going to beir your is going to be your herpy Simplex your r r g to be your uh covid-19 your rein riin um just know that um women of child bear in ag should be advised to use barrier contraceptives if they're are if they are taking REO bear so keep that in mind um me see remember ntin could be um mixed up with the other medication niine so remember those are sound sounds alike looks alike drugs so please do not confuse about it about two questions may be about antifungals so um the main thing for this one uh most most antifungal should be should not be taken with heavy alcohol use right remember monitor alt a with ungles okay now we're going into anti-hypertensives I believe this is going to be the last realm I'm going to be going over I believe before the general um Concepts that'll be going over so anti-hypertensives of course um heart rate stroke volume and total peripheral resistance those are going to be your three elements of the cardiovascular system the pressure in the cardiovascular system okay African-Americans the this ethnic group just know that uh they are less responsive to Angiotensin converting anite Inhibitors than beta blockers African-Americans are more responsive to diuretics and the treatment approach should include the first line use of a diuretic in combination with diet and other Lifestyle Changes normal Ras process so um so know that the first step is usually the what usually the order of the process usually goes as follows so usually the low BP is detected then after that the the kidney cells identify decreased profusion and secrete renin three angiotensinogen in the liver and rein are converted into Angiotensin one Angiotensin one is converted to Angiotensin 2 in the lungs this is where ACE inhibitors work and this is where blood pressure increases so keep that in mind how how far are we we're in 24 out of 46 we're almost there about somewhat so now for ACE inhibitors I want you to the most important thing have first effects and mode of action okay for ACE inhibitors it prevents uh the conversion blocks it so inhibits it remember the the the similar the similar the antonym well not antonym synonym I'm sorry the synonym of inhibit is block so prevents it prevents and blocks the conversion of angiotensin one to angiotensin two leading to decrease in blood pressure and heart rate a decrease in aldosterone production and a small increase in serum potassium levels along with sodium and fluid loss adverse effects adverse effects to ACE inhibitors think of ace angio angio edema dry cob and extra potum we went over this you not use this medication if a person is pregnant or lapta you know this laran laran Kar loan is going to cause vas dation by preventing Angiotensin 2 from binding it site right if the patient's hypertension isn't controlled with arbs then you want to give a hydrochlor thyde okay remember avoid standing up too quickly unless you know how drug works because what is going to what what is going to be another aage support to Angiotensin receptor blockers orthostatic hypotension so keep that in mind don't stand too quickly try not to change your position too quickly because that's going to be a result of that beta blockers usually this usually uh causes a decrease in heart rate decrease in myocardial contractility SI node decreased rate of conduction AV node right um and all that for beta blockers there's going to be two types beta beta one and beta two beta one blockers usually are selected right it targets only the heart this includes mopolo and Propranolol right remember one of the adverse effects is going to be bra cardia this can mask hypoc yeah so keep that in mind all right now beta beta 2 blockers beta two blockers are going to be non- selective and usually uh panalo is going to be um the medication associated with beta 2 but panol La keep in mind is both beta 1 and beta 2 block so it has the best of both wordss um the adverse effects to Beta 2 blockers it's important to a avoid patients with asthma and COPD orocco constriction right patients with diabetes should be given a selective beta one Blocker in addition decreased heart rate canas hypoglycemia so if a person is diabetic give them beta 1 do not give them beta 2 [Music] yes calcium channel blockers so for calcium channel blockers this is your VAP Mill nyine delium and and your otene um there are two uh categories I would say for colum channel blockers there's your dihydropyrenes which ispine and your non hydrop pyodine right your dihydropyridine is going to be your medication that's gonna not affect the heart rate but it's gonna cause the vassel dilation to become stronger right for non- dihydro pyes it's going to help lower the heart rate and will have less FAS vation than dihydropyrans so keep that in mind um do not take if you're pregnant obviously you know this all right vasodilators remember let's just review again what respiratory condition do you give Vaso dilators to I'll give you five seconds while I fight so viso dilation so remember vasil dilators you want to give it to patients who have empa right to open up lungs dealing with structural change so EPA you can give Vel dilators to EPA all right very good that was a good review we went over with that now let's go back [Music] um place so these are your vas so nitrite these are all your emergency drinks all right so I want you to keep in mind um dealing with the heart with so much of your heart and your circulatory system your emergency drugs will be your di uh your these drugs your diazide hydroline and then trop aside the emergency drugs dealing with your your lungs really will be your your epinephrine and your albuterol medications so those are these are all your emergency drugs all right um nitrite is used for hypens of Crisis Malin hypothermia right so make sure you you monitor your blood pressure with um heart failure about one two three questions usually okay one question what is going to be the antidote for hyp heart failure or if a person I'm sorry if a person has is taking the Joon right and there's the theox and dose is too much what are you going to give digifab right um the main U main thing for for djon you want to take uh must take an you must take an at epical Pulse for full 60 seconds and then hold if the heart rate is less than 60 right hypokalemia can make jockin toxic so monitor your potassium levels as appropriately and remember yellow Halos watch for toxicity visual changes anorexia nausea and effects usually show within five to 30 30 minutes so keep that in mind if a person has those yellow Halos when they're taking dejin usually that's going to be a good indication that they're experiencing visual changes and that's going to be those signs and symptoms for ditch toxicity all right if that happens you want to get digifab or the dexin immune fab right that's going to be the antidote for ditch toxicity or overos right this is the this is the therap therapeutic serum dit toxicity levels so let's say if therapeutic levels is out of three or four then you would give that dig so remember those therapeutic ditch levels so that's going to be very important right your antic coagulants four to five questions about this yes so Heparin Heparin is going to be fast acting right used for BBT Mi PE and EIC therapeutic dose for this is going to be 1.5 to3 um times the a a t Baseline if the AP is out of range hold the dose and call the doctor to inform the result okay remember don't get the this level confused with the dig dig is usually 0.5 to2 temin is 1.5 to3 okay if the person overdoses in Hein you want to give ramine sulfate very good anticoag warin also known as cumin the therapeutic range for for warrin with Ion on that's two and between two and three two to three so again Rie what's a therapeutic level for digit toxicity 0. five to I just want to so I don't have to uh to give you wrong information remember for um for dig toxicity um for dig oxin in general the therapeutic level is GNA be 0.5 to two if the per if the therapy levels are out out of whack not within those normal normal range for dejin you want to give dig fet now with a person that um is taking hapin remember it's going to be 1.5 to three if the the that's going to be the therapeutic level for a if the APT is above that range you want to get protamin now with warrin it's going to be two to three for your Ion your ionine and that's going to be Warframe if it's out of range then you're going to give Vitamin K Vitamin K is going to be the antidote for Warf right diet should have a consistent amount of vitamin K containing food so it is not this so as to not cause fluctuations in bleeding time so keep that in mind Reaver roxan Reaver rockan is going to be your um preferred medication over Hein and warin Hein and warin okay um yeah no dietary restrictions are ongoing lab test needed there that most important adverse effect for all medications is going to be bleeding for this one rivox okay just a quick review nursing priorities for anti-coagulants do not administer any conditions that would cause more bleeding right um number two continually assess for bleeding the antidote for warin is Vitamin K antidote for Heparin is going to be camine sulfate so keep that in mind now t TK right usually before you give tnk you want to give um you want to order a CT MRI CT scan for the patient it's Contra indic it's usually contraindicated um with any patient with any condition due to the risk of of if it's gonna be an es schic attack or hemorragic if the person is bleeding don't give 10 KCK because that's gonna be very bad it's gonna cause more bleeding so usually that's gonna break the thrus that has been formed so before giving send the patient to CT scan or MRI to determine es schic or hemorrhagic stroke yes called pit gril it's it's a good drug very good drug I like that drug so antiplatelet aggregator it decreases the stickiness of platelets by blocking receptor sites right it's going make the plets less sticky right it's like aspirin right it's going to help decrease the those CLS right um ttis GI bleeding here uh it's going to cause that right so keep knowing about C group and Aspen there those are your anti aggregators anti- andinas there's about two to three questions about this so I'm not going to stress you out about this one just know natural glycin is going to be your first L treatment for antias that a effect to um for nitroglycerin is that one yeah for usually low BP and headaches keep that in mind if a person is taking natural glycerin right natural glycerin um it's important to take five minutes apart right if the pain is not Rel by three tablets remember three tablets usually that's about 15 minutes is 5 * 3 15 call 911 don't give anyone this this is a problem that we need to call very good and yeah that's about pretty much it for that lipid lering uh agents uh for two it's about three two to three questions so remember this question um remember these Concepts so it's important to observe the signs of toxicity with a toastin atorvastatin Sy sasta muscle pain and rabdom mysis right monitor your a don't take alcohol with this one observe signs of toxicity muscle pain and rapdom Analysis do not give the patient with gra graer juice these can cause toxicity remember graer juice is an inhibitor please don't give it it's bad all right um associate the med to the class of drug colos thyro me is your bio acid sequestrant no about that adverse effect cholestyramine direct GI irritation or H hemorrhoid irritation so keep that in mind nine this is a fun Med if the person is Flushing give the person aspirin please thank you um you can also take with meds but the priority number one is going to be your um your aspir to reduce the risk of flushing because flushing is going to be um one of the side effects so give Aspen um see let me see let me see you don't have to worry about that remember if I if I don't go over it please just associate the drug with the with the med the drug class that thank you okay next is going to be your diuretics about four questions about this all right um the main thing with diuretics it's important to monitor daily weights at the same time every day usually in the morning right same time every day in the morning Loop Diuretics so Loop Loop Diuretics and potassium wasting diuretics usually this is feride um the main thing for fosmid this is potassium feering potassium wasting right so what's going to be an aers effect going to be correlated with this hypokalemia hypokalemia right so what is important to educate the patient about this medication right you want to educate on a good diet high in potassium high in potassium which is GNA which is going to include raisins dried fruits artichokes all that good stuff as well as avocados avocados are very good with potassium um for potassium do you do push potass no unless you want to give your patient a death sentence no that's bad bad bad bad um don't give too fast um um forine don't push it too fast don't give too too fast of potassium because this this can cause hypotension in ttis okay ttis ringing in the ears and hypotension so keep that in mind um and know that fosite is a l diuretic and a potass wasy um medication passive sparing diuretics S for S so sparing and spar laac to right um the main thing about this it's no risk for this is going to be hyperia increase um increased potassium LEL so don't eat too much high potassium foods make sure to monitor your potassium intake all right very good thide like diuretics potassium wasting so this is going to be your thighside like the main thing is to observe your hyper IC acid levels right and this medication could cause elevated blood sugar levels so monitor your patients with diabetes very carefully if they're taking actual clor yeah manol is going to be your osmotic B okay it's going to pull water into the renal Tube without sodium loss this is this is repeting um Carbonic and Hydra Inhibitors this is g to deal with your glaucoma okay all right anemia there's about two questions in your exam so keep in mind about this if you have a pediatric patient who's who's order to um take a Fier sulfate for iron deficiency right um to decrease tooth staining drink uh drink Fair sulfate with um with a straw okay adverse effect to herir sulfate would include GI upset dark green black stools they are very common um to prevent irritation the the best rout is to be given uh what did I do I'm sorry um where was I so to prevent irritation um the best route to give this patient is going to be um INR muscular the z track method right um again this is separate to the peed so if if the the patient is order for for liquid iron through the straw but if it's going to be an injection usually I am is going to be the preferred to prevent irritation okay um one of the adverse effects is always going to be it's always going to it's going to be constipation right so if the patient experiences constipation with fous sulfate you want to encourage fibber in fluids now if a patient this is when iron is too low and now if the patient has too much iron over overuse of iron levels then deferoxamine is going to be your agent to to treat that overdose toxic iron levels so keep that in mind um folic acid that's dealing with vitamin B9 canano cobalamin that's for your vitamin B12 your megaloblastic pernicious anemia right B12 is usually abored in ilium located in the small bow okay EPO this is your rthro poisa stimulating agent nomic anemia and that's going to be all the medications that I've talked about now I'm going to be going over briefly about Concepts that we talked about in the past so so this is going to be important okay um the five patient rights to medications know that there's the right dose the right time the right patient the right route the right drug the Right Storage the prep recording those are going to be very important all your patient HS now your pregnancy risk okay um acetam medifin that's a category B pregnancy risk remember the benefits outweigh the risk right usually um again the the risk usually goes from less risk to most risk um that's category a to category B remember um any risk the fetus is going to be teratogenic right and this is going to be your categories for medications when you think of categories please associate that with pregnancy not not like um not the level of abuse of drugs right categories associated with pregnancy schedules are associated with abusive medications um acetoin is a category B medication linil um is a category D right um benefits outweigh the risk category X these are no good atorvastin and kumaden um this this can cause uh harm to the fetus so don't give category X medication to pregnant women okay category C used to replace human chemicals that are not produced because of or genetic problems remember anything trogen by definition is having adous effects on the fetus which can cause death or congenital defects remember this comes from all our classes well um all our nursing classes so know about the nursing process assessment diagnosis planning implementation evaluation evaluation is a continual process right of the patient care okay implementation is basically um going forth with um the plan so that's going to be your Drug Administration your provisional Comfort measures and all that patient education that's implementation planning is B basically setting your goals setting your goals for your patient and the planning planning process is usually involved with all of the health care team especially with the patient a diagnosis diagnosis is going to be usually nursing nurses can't diagnose but there are nursing diagnosis there is a nursing diagnosis um assessment for assessment there's a um remember is system Systema IC assessment usually obtains all that objective and subjective information of the patient so keep that in mind priorities for nurses to take in the event of a medication error make sure to stop the infusion first and contact with all right so keep that in mind these are all signs for anal reaction shortness of breath wheezing BP changes rashes itching difficulty swallowing attack cardia so if you're anxious bu and all that do you crush extended release medications no do not because this will damage the interior coding increase and increase the drug levels what are the reliable sources for drug information and administration with been caughts nursing drug guide Physicians drug for reference what does the what does drug half life mean and how do you determine it absorption from the side of Entry route can influence absorption Orly rect vagin vaginal and all remember um for IV um the fastest absorption is going to be uh the fastest absortion for absorption is going to be IV if not IV some new um remember for metabolism liver is going to be associated with metabolis ISM pH of pharmacokinetics remember pharmacokinetics add me absorption distribution metabolism and excretion distribution is how the drug moves into the tissues right abum is going to be the usually the level where you check for for the distribution pH okay metabolism usually the liver involved so altas these going be important the first passive effect occurs with the metabolism uh stage of phaco kinetics so know about that EXC creation from the body um usually uh is dealt with the kidneys right so keep that in mind remember um all know all this um remember um grapefruit juice no don't give it because it's gonna help it's gonna toxify the medication so do not do that for Peaks and troughs the difference between troughs and Peaks remember uh trough that you're going to draw 30 minutes before giving the next medication dose and Peak is going to draw one hour and 30 minutes after um Peak is gonna be you're going to draw one hour and 30 minutes after Administration what can happen when two highly protein drugs are given together two medications May compete for the same binding site leading to toxicity of one of the medications so keep that in signs of symptoms of renal and liver liver insufficiency remember renal insufficiency kidneys so if the B bun level 7 to 20 right if it's over 20 it's toxic there's there's toxicity occurring creatin levels if it's above 1.3 there's a it's a bad kidney and you also want to check GFR for GFR if it's above 60 then that's really good if it's less than 50 that's increased risk for kidney failure so keep that in mind remember indications for liver damage pain jaundice High LT a we're almost done remember about Morphine Morphine is an Agonist um and noox is GNA be an antagonist okay and now these are the final things so laps glucose 70 to 110 A1C if it's above 60 .5% that's usually indicative of diabetes keep that in mind potassium 3.5 to5 crafting levels remember if it's above 1.3 there there's some sort of kidney damage so keep that in mind WBC um ATI and the book is different 4 to1 um if it's elevated it's infection um usually we learn it's 5 to 10 but for pharmacology it said 5 to 11 um do as your wish which which lab level you um you you like in reference of WBC this is what what it just says on the study gu alt a high levels um are included high levels of alt a usually are indicative of liver disease for CD4 count we talked about this with my th highballs the higher the number usually the better okay and remember hypothyroidism if it's high TSH and there's a low T3 and T4 that's G to be hypothyroidism if it's a low TS and high T3 and T4 that's going to be hyperthyroidism so know about those differences and that's going to be the full indepth review of the study guide um hopefully this helps you um with your final exam um I hope this helps a lot and this will help you guys pass so I appreciate the contributions to um all of everyone's contributions to this exam um this exam review I appreciate it and that's going to be where I'm GNA end my oh before I end I just want to mention usually uh don't forget to U review over this before the exam and also don't forget to take all those practice tests and make sure to teach each other um usually get one person to teach um the material to remember teaching back the information is going to help you obain the information if you can teach it then you understand the information right and that's where I end off good luck on your final exam for Farm This Is Where I Leave You Off with ad do