[Music] All right, welcome future nurses. My name is Mark Johnson. I'm an ENCLEX instructor and an ICU nurse. And today we are tackling one of the biggest hurdles in nursing school, pharmarmacology. My goal is to help you stop memorizing and start understanding. I want you to actually get why medications work the way they do, how they move through the body, and how to recognize patterns that will make this content stick. Not just for the exam, but for real life nursing. Pharmarmacology is huge. I won't lie. But it doesn't have to be overwhelming. When you break it down, it's manageable and honestly even kind of fun once it starts to click. This enclelex pharmarmacology mastery course will consist of 15 topics. Introduction to pharmarmacology, autonomic nervous system medications, cardiovascular medications, respiratory medications, corticosteroids, anti-coagulants and antiplatelets, pain sedation and anesthesia, endocrine medications, gastrointestinal medications, infectious diseases medications, emergency and critical care medications, psychotropic medications, also known as mental health meds, reproductive and generinary medications, miscellaneous must know medications, and finally, we'll wrap it up with Enclelex style practice questions. And if you want to follow along this lecture with the detailed and visual notes, check out our pharmarmacology mastery notes on our website, your nursingspace.com. Let's start at the foundation. How medications move through the body and how they produce their effects. This brings us to two key concepts, pharmaccoinetics and pharmacodnamics. First, pharmaccoinetics. It's the journey of a drug through the body. Pharmaccoinetics is what the body does to the drug. The process follows four key steps which we remember with the acronym ADME. Absorption, distribution, metabolism, and excretion. Let's go through them one by one. Absorption is how the drug enters the bloodstream. This depends on the route of administration. For example, drugs given by IV go directly into the bloodstream. That's the fastest method. Oral medications or PO take longer because they have to go through the digestive system first. They're absorbed through the stomach or intestines and then processed by the liver. That leads us to the first pass effect. This only applies to oral medications. When a drug is absorbed through the GI tract, it first goes to the liver. The liver may metabolize a portion of it before it ever reaches circulation. that reduces the drug's bioavailability which we'll talk more about later. Distribution is how the drug travels through the bloodstream to reach the tissues and target organs. One major factor here is protein binding. Some drugs bind tightly to plasma proteins like albumin. If a drug is highly proteinbound, it stays in the circulation longer because only the unbound portion is active. Warferin is a perfect example. It's about 99% proteinbound. That's why it interacts easily with other drugs that are also proteinbound. Small shifts can lead to big effects. Metabolism or bot transformation is how the body breaks down the drug mostly in the liver. The liver uses enzymes especially the cytochrome P450 system to break down many medications. If a person's metabolism is slow, the drug can build up in the body over time. That leads to a higher risk of toxicity. On the flip side, if metabolism is too fast, the drug may wear off before it has time to work. Excretion is how the drug leaves the body. Most drugs are excreted through the kidneys. So, we always want to monitor creatinine in BUN levels to check kidney function. In patients with kidney disease, drugs may not be eliminated properly. They can accumulate which increases the chance of side effects or toxicity. Quick recap. The four steps are absorption, distribution, metabolism, and excretion. That's a DME. I like to remember it with the phrase a drug must exit. Now, let's switch gears. Pharmacodnamics is what the drug does to the body. This is where we talk about mechanisms of action. How drugs produce their intended effects. The most common mechanism is receptor binding. Drugs can either activate receptors or block them. When a drug activates a receptor, it's called an agonist. An example is albuterol, which stimulates beta 2 receptors in the lungs. This opens up the airways and helps patients breathe easier. On the other hand, when a drug blocks a receptor, it's called an antagonist. A good example is a beta blocker like merolol, which blocks beta receptors and slows down the heart rate. Another important concept is the therapeutic index. This refers to the safety margin of a drug. A drug with a narrow therapeutic index has a small window between the effective dose and the toxic dose. That means we need to monitor those patients closely. Let's go over a few more terms that are frequently tested and highly relevant in practice. First, half-life. This is the amount of time it takes for half the drug to be eliminated from the body. If a drug has a short half-life, it leaves the system quickly, so it may need to be taken more often. If it has a long half-life, it stays in the body longer, which means we can space out the doses. Next is bioavailability, which we touched on earlier. This refers to the percentage of a drug that actually reaches the circulation and is available to do its job. Because of the first pass effect, oral drugs often have lower bioavailability than drugs given by IV. Now, let's look at drug classifications and those magic little suffixes that help you identify what kind of medication you're dealing with. Let's go through a few of the most common ones. Drugs that end in prill are ACE inhibitors like linopril, which are used to treat hypertension and heart failure. LOL means the drug is a beta blocker like metaprolol which are used for high blood pressure and arhythmias. Check the table in the notes for more examples. Knowing these suffixes helps you quickly identify the drug class, its use, and often its most common side effects. Controlled substances are categorized based on their potential for abuse and addiction. The schedule runs from 1 to 5. Schedule one drugs are illegal. They have no accepted medical use. Examples are heroin, LSD, and ecstasy. Schedule 2 drugs have a high abuse potential but are used medically. This includes morphine, oxycodone, and rolin. Schedule 3 drugs have a moderate risk of abuse. Examples include codin and ketamine. Schedule 4 drugs have low abuse potential. This includes bzzoazipines like Xanax and Valium. Schedule 5 drugs have the lowest potential for abuse. Examples are cough syrups that contain codine. To help remember this, try the pneummonic. I am the fighting nurse. I for illegal, A for addictive, T for therapeutic, F for few risks, N for not a big deal. Let's talk about pregnancy safety categories. These range from A to X. Category A is the safest. There's no risk to the fetus in human studies. Examples include folic acid and levothyroxine. Category B shows no risk in animal studies, but there are no well-controlled studies in humans. Examples are amoxicylin and zopran. Category C shows risk in animal studies, but the benefits may outweigh the risks. This includes fuoroquinolones and SSRI medications. Category D has evidence of fetal risk, but the drug might still be used if the benefits outweigh the dangers. Examples are ACCE inhibitors and phenotonin. Category X means absolutely contraindicated in pregnancy. These drugs cause fetal abnormalities and should never be used. Examples include warfarerin and isotriinino. All right, let's jump into the autonomic nervous system or ANS for short. This system controls the stuff your body does automatically. Think of things like heart rate, digestion, breathing, urination, and blood pressure. basically all the behind-the-scenes action that keeps you alive without you even thinking about it. The ANS has two major branches. Let's break them down. The first is the sympathetic nervous system. This is your fight orflight response. When it's activated, your body gets ready to defend itself or run like crazy. It increases heart rate and blood pressure, opens up your airways, shuts down digestion and bladder function, and gets energy ready for use. The second is the parasympathetic nervous system. This one's your rest and digest mode. It does the opposite. It slows your heart rate, brings your blood pressure down, and ramps up digestion and urinary activity. It conserves energy and keeps things calm. Now, let's look at how medications interact with these systems. Adronic agonists activate the sympathetic nervous system. That means they increase heart rate, raise blood pressure, and open up the lungs. Here are some examples and what they're used for. Epinephrine is used for anaphilaxis, cardiac arrest, and shock. It raises the heart rate, increases blood pressure, and causes bronco dilation. It's a lifesaver, literally. Albuterol is a rescue inhaler used in asthma. It works by opening up the airways fast. Dopamine is used in shock and heart failure. It helps raise blood pressure and improves kidney profusion. Phenylfrine is used for nasal congestion and low blood pressure. It causes vasoc constriction. As for nursing considerations, always monitor blood pressure and heart rate. These drugs can easily cause hypertension and tacoc cardia. Be careful in patients with heart disease. These meds increase cardiac workload. And with aluterol, watch for tremors and palpitations. Those are common side effects. Here's a helpful tip. Alpha equals arteries. Beta equals beats and breathing. Alpha 1 agonists constrict blood vessels and raise blood pressure. Beta 1 agonists increase heart rate and force of contraction. Beta 2 agonists open up the lungs through bronco dilation. All right, next up we're talking about adronurgic antagonists, also called sympatholytics. These drugs do exactly what the name suggests. They work against the sympathetic nervous system. So instead of revving up the fightor-flight response like adinuric agonists do, these drugs hit the brakes. They block alpha and beta receptors which leads to lower heart rate and lower blood pressure. Let's start with the alpha blockers. These drugs end in zosin. Two of the big names here are prozzosin which is used to treat hypertension and sometimes benign prostatic hyperplasia or BPH and tamsloin which is more selective for the prostate. It's commonly used to treat BPH, helping to relax the muscles in the bladder and improve urine flow. So if you think of alpha blockers, just remember they open up the blood vessels and relax the smooth muscles, especially in the urinary tract. Now let's move on to beta blockers. Beta blockers are split into two categories, selective and non- selective. Selective beta blockers like metaprolol and aenol mainly block beta 1 receptors in the heart. These are used for high blood pressure, angina, and heart failure. Because they focus on the heart, they're generally safer for patients with asthma or COPD. On the other hand, non- selective beta blockers block both beta 1 and beta 2 receptors. So, they affect both the heart and the lungs. Examples include propranolol and carvettool. These are used for things like hypertension, anxiety, and migraine prevention. But you want to be careful in patients with respiratory issues because blocking beta 2 receptors can cause bronco constriction. Let's talk about the key nursing considerations for all beta blockers. First, always check the patients heart rate before giving a beta blocker. If the heart rate is less than 60 or the systolic blood pressure is below 100, hold the medication and notify the provider. Second, do not stop beta blockers abruptly. Stopping suddenly can cause rebound hypertension and tacocardia which can be dangerous especially in cardiac patients. And finally, if your patient is diabetic, monitor them closely. Beta blockers can mask the symptoms of hypoglycemia. That means they might not feel the usual warning signs like shakiness or palpitations. Always make sure they're checking their blood sugar regularly. All right, let's move into conuric agonists also known as parasympathomimedics. These drugs stimulate the parasympathetic nervous system. And remember that's your rest and digest system. So what happens when these drugs kick in? They help the body relax. They increase secretions, slow down the heart rate, and promote digestion and elimination. They do this by acting on muscerinic and nicotinic receptors which are located all over the body from the heart to the GI tract to the brain. Let's walk through the most common agonist drugs and what they're used for. Bethany is used for urinary retention. It stimulates bladder contraction and helps patients urinate. Pyocarpine is used for glaucoma and dry mouth. It increases fluid drainage from the eye and also helps produce saliva. Carbol is another glaucoma medication. It works similarly by reducing intraocular pressure. Then we've got a group of drugs used for neurological conditions. Donapacil and rivastigmamine are used in Alzheimer's disease. They work by increasing levels of acetylcholine in the brain which can help with memory and cognitive function. And for mythenia gravis, we have pyroostigmine and neostigmine. These drugs improve communication between nerves and muscles, boosting muscle strength. Now, here's where you need to be careful. If too much acetylcholine builds up in the body, we can see a chonergic crisis, and that's not fun for anyone. To remember the symptoms, use the pneummonic S lug gbb. Chonergic agonists make everything wet and slow. Here's what that stands for. S salivation, Lacrimmation, which means tearing. Urination, Diarrhea, Gastrointestinal upset, Emesis or vomiting, and the three Bs, brady cardia, slow heart rate, bronco constriction, narrowed airways, bladder contraction, increased urinary urgency. If your patient is showing these signs, it might mean they're having a coneric crisis. The antidote is atropene. It's an antiolineric that blocks the parasympathetic system, reversing symptoms like bradic cardia and excessive secretions. Let's go over a few nursing considerations for these meds. Bethanyol should be taken on an empty stomach to reduce nausea. Pyocarpine should be used cautiously in patients with asthma or COPD because it can cause bronco constriction. Donapacil is best given at bedtime. that helps reduce dizziness during the day. With neostigmine or puridostigmine, watch closely for muscle weakness. If the dose is too low, the patient might be in a mythenic crisis. If it's too high, they could go into a coneric crisis. Both conditions cause weakness, but one needs more medication and the other needs less. That's where close monitoring and clinical judgment really matter. Now that we've talked about cononergic agonists, let's look at their opposite chonergic antagonists, also known as antiolinergics or parasympathetics. These drugs block the parasympathetic nervous system by inhibiting acetylcholine receptors. And when you block the rest and digest system, you get the opposite effects. You see an increase in heart rate, bronco dilation, drying of secretions, and urinary retention. Let's walk through the most common medications in this category and their uses. First up is atropene. This is a go-to emergency drug used to treat brady cardia or a dangerously slow heart rate. It also dries secretions before surgery and acts as the antidote for organo phosphate poisoning which is something we rarely see but it's still tested on enclelex. Next is scopalamine. This one's great for motion sickness and like atropene, it's also used to dry up secretions before surgery. It comes as a patch you apply behind the ear and it needs to be replaced every 72 hours. Atropium and tiatropium are commonly used for COPD and asthma. These meds help with bronco dilation and reduce mucus production. Just remember, they are not rescue inhalers. They take time to work, so they're more for maintenance than immediate relief. Oxybutin and tolerodin are used for overactive bladder. They relax the bladder muscles which helps prevent frequent urination. These are super helpful but they should be avoided in patients with BPH or benign prostatic hyperplasia because they can make urinary retention worse. Benstropene and trihexifenodal are used in Parkinson's disease. They help reduce tremors and muscle rigidity by restoring the balance between dopamine and acetylcholine in the brain. However, be extra cautious with elderly patients since these drugs can cause dizziness, confusion, and increase the risk of falls. And finally, we have descine which is used for irritable bowel syndrome or IBS. It helps reduce bowel spasms, making it easier for patients to manage painful cramping. Now, let's talk about what you really need to watch for the classic antiolineric side effects. We remember them with the phrase can't see, can't pee, can't spit, can't shard eat. That means blurred vision, urinary retention, dry mouth constipation. Basically, everything dries up and slows down. So, what are the key nursing considerations for atropene? Always monitor the heart rate. Too much can lead to tachicardia and avoid it in patients with glaucoma because it increases intraocular pressure. With scopalamine, make sure the patch is applied correctly behind the ear and that it's replaced every 72 hours. Forropium and tiatropium, remind patients that these are not rescue inhalers. They won't work for an acute asthma attack and they need to be taken regularly to be effective with oxyetin. Avoid giving it to patients who have BPH since it can worsen urinary retention. Benstropene requires caution in older adults, especially due to the increased risk of confusion and falls. Here's a quick pneummonic to tie it all together. Anti-olonic means anti-chill. These drugs dry everything up. So again, can't see, blurred vision, can't pee, urinary retention, can't spit, dry mouth, can't sh constipation, simple, easy to remember, and definitely testable on the enlex. All right, now that we've covered the basics of pharmarmacology from the intro all the way to autonomic nervous system meds, let's switch gears and do a little inclelex style practice. Nothing too intense to start with. We'll warm up with some easier questions and then ease into the trickier stuff. Sound good? Okay. Question one. Which pharmacocinetic process is most directly affected when a patient has liver dysfunction? A absorption. B distribution. C metabolism. D excretion. And the answer is C metabolism. The liver is like the body's processing plant for drugs. And if it's not working properly, drugs can stick around longer than they should and that raises the risk of toxicity. So yeah, liver equals metabolism. Next up, a patient has developed a tolerance to a drug. What change is expected in its pharmacamic response? A increased therapeutic effect. B decreased response at the same dose. C enhanced drug absorption. Duced drug metabolism. Answer is B. Decreased response at the same dose. Basically, the body's like been there, done that, and doesn't react the same way anymore. This happens when receptors become less sensitive. So, you don't get the same effect without increasing the dose. Moving on, a patient with chronic hypertension is prescribed auterol for asthma. The nurse should monitor the patient for which potential interaction between albuterol and their beta blocker say meto prol. A increased risk of hypotension. B decreased broncoilation effect. C excessive central nervous system stimulation. D severe bradicardium. Answer is B. Decreased broncoilation effect. Albuterol works by stimulating beta 2 receptors to open up the airways. But beta blockers can block those same receptors, especially at higher doses, even if they're selective. So, you've got one drug trying to open the airways and another blocking that signal. Not the most cooperative combo. Next question. Which clinical finding best indicates antiolineric toxicity in a patient taking benstropene for Parkinson's disease? A. Brady cardia and constricted pupils. B. dry mouth, confusion and urinary retention. C. Lacrimmation and bradic cardia. D. Nausea, vomiting and diarrhea. Correct answer. B. Dry mouth, confusion, and urinary retention. This is your classic antiolineric overload. If you've ever heard the saying dry as a bone, matt as a hatter, full as a flask, this is what they're talking about. Dry mouth, mental fog, and that lovely inability to pee. Last one. A diabetic patient is prescribed propranolol. What's the most important adverse effect the nurse should monitor for? A. Hypercalemia. B. Reflex tacicardia. C. Mass symptoms of hypoglycemia. D. Increased insulin sensitivity. Answer. C. Mass symptoms of hypoglycemia. Propranol blocks beta receptors, including the ones that help the body respond to low blood sugar. So those usual warning signs like shaking or a racing heart, they might not show up. Kind of scary, honestly, because the patient might not even know their sugar's crashing. The only sign that tends to stick around is sweating. All right, that wraps up part one of our pharmarmacology mastery series. If this helped you out, don't forget to subscribe and hit the notification bell. so you catch part two and all the other good stuff coming your way. Again, if you're looking for this pharmarmacology mastery notes, they're ready for you on our website. You can also check out our test bank platform, Exam ASAP, our advanced adaptive testing platform, featuring over 5,000 peer-reviewed questions designed to mirror the ENLEX experience. It includes detailed ration, daily content updates, and a 247 AI tutor resources recognized as industry-leading and proven to enhance your performance. Not only that, our question bank platform has next generation enclelex question types with case studies. We are adaptive and AI powered platform that allows you to pass the enclelex the first try. With our question bank platform, you are able to see the analysis of how ready you are for the ENCLEX exam with a detailed analysis based on your performance. So check out our website for all those goodies. And I hope this lecture helped you feel a bit more confident with the pharmarmacology section, whether you're studying for nursing school or gearing up for the ENCLEX. Again, I'm Mark Johnson, your ENCLEX instructor here at YNS, and I'll see you in the next lecture. [Music] Welcome to part two of our ENLEX pharmarmacology lecture. If you haven't yet watched the first part, I highly encourage you to go back and start there. In that session, we laid the groundwork looking at how pharmarmacology is tested on the enclelex and how to approach it from a clinical testbased mindset. That foundation will help you move through this next phase with clarity and confidence. My name is Mark Johnson. I'm an ICU nurse and your enclelex instructor here at YNS. In today's session, we're diving deeper into pharmarmacology, breaking it down system by system. We'll begin with cardiovascular medications, specifically anti-hypertensives, which are not only high yield for the exam, but absolutely essential to safe, effective nursing practice in any setting. And if you want to follow along this lecture with the detailed and visual notes, check out our pharmarmacology mastery notes on our website, your nursingspace.com. Okay, without further ado, let's dive into the number one pharmarmacology mustnos cardiovascular medications. When we talk about blood pressure medications, it's helpful to remember the classic framework, the ABCD of anti-hypertensives. This stands for ACE inhibitors and ARBs, beta blockers, calcium channel blockers, and diuretics. Each class works differently, affects different systems, and requires different nursing considerations, but they all aim toward the same goal, protecting the heart, the brain, and the kidneys by managing hypertension. Let's begin with the Ace inhibitors and ARBs which both work within the rean angotensin aldoststerone system. One of the most powerful regulators of blood pressure in the human body. ACE inhibitors easily recognized by the suffix dashpry include medications like leinopriil and alalopril and captopril. These drugs block the angotensin converting enzyme which is responsible for transforming angotensin 1 into angotensin 2, a potent vos constrictor. By inhibiting this enzyme, ACE inhibitors reduce vasoc constriction, decrease blood pressure and ease the workload on the heart. These medications are commonly used not only for hypertension but also for heart failure and for kidney protection in patients with diabetes. However, ACE inhibitors are known for a few signature side effects. Most notably, they can cause a dry, persistent cough, which is thought to result from increased levels of bredinine. While not dangerous, the cough can be disruptive enough that patients may ask to stop the medication. More concerning is angioadema, a rare but serious reaction involving rapid swelling of the lips, tongue, or throat. If this occurs, the medication must be stopped immediately. ACE inhibitors also raise potassium levels. So we need to monitor for hypercalemia and patients should avoid potassium supplements or salt substitutes unless specifically instructed otherwise. If a patient cannot tolerate an ACE inhibitor particularly due to the cough, we often switch to an ARB or angotensin 2 receptor blocker. These drugs such as loss art, valsarton and telmasartin end in sarton and work by blocking the receptors that andotensin 2 binds to. The effect is the same lower blood pressure and reduced vascular resistance but without increasing bradykin levels. This means no cough and a much lower risk of angioadeema although it's not zero. Like ACE inhibitors, ARBs can also cause hypercalemia. So potassium levels must still be monitored. With those vasoddilatory mechanisms covered, let's move on to B beta blockers, a cornerstone of cardiovascular pharmarmacology, especially in patients with hypertension, arrhythmias or a history of myioardial inffection. Beta blockers which end in LOL include familiar names like meaprolol, aenol, propranolol, and carvettool. These medications work by blocking the beta adinuric receptors in the heart primarily beta 1 receptors thereby reducing the effects of adrenaline. This slows the heart rate decreases myioardial contractility and ultimately lowers blood pressure. Some beta blockers like metiprolol and atinol are cardio selective meaning they primarily affect the heart and are safer in patients with asthma or COPD. Others like propranolol and carvettool are non- selective and should be avoided in patients with reactive airway diseases because they can cause bronco constriction by also blocking beta 2 receptors in the lungs. From a nursing standpoint, beta blockers require careful pre-administration checks. Always assess the heart rate and blood pressure before giving the dose. If the heart rate is below 60 beats per minute or the systolic blood pressure is under 100 millimeters of mercury, the medication should be held in the provider notified. These drugs should never be stopped abruptly as doing so can cause rebound tacocardia or even hypertensive crisis. For diabetic patients, keep in mind that beta blockers can mask the early signs of hypoglycemia, especially the typical increase in heart rate. So, blood glucose monitoring becomes even more important. Next we move into C calcium channel blockers. These drugs prevent calcium from entering the muscle cells of the heart and arteries resulting in decreased contractility and vasoddilation. The result is lowered blood pressure and in some cases a reduced heart rate. Calcium channel blockers are divided into two groups. The dipine drugs like amloipine and nifodapine which primarily act on blood vessels to cause vasoddilation and lower blood pressure and the non-dihydropodines verapl and deltism which also affect the heart's conduction system and are often used to manage arhythmias like atrial fibrillation. Nursing considerations for calcium channel blockers include assessing blood pressure before administration. If the systolic pressure is below 100 millm of mercury, you'll generally want to hold the dose. Patients should be cautioned not to consume grapefruit juice as it can inhibit liver enzymes and raise the drug concentration to potentially dangerous levels. Additionally, these medications can cause peripheral edema as well as dizziness, particularly with the first few doses due to their vasodilatory effect. Finally, we arrive at Diuretics, a critical class of medications used to eliminate excess fluid from the body, which in turn reduces blood pressure in the heart's workload. There are several types of diuretics, each with its own clinical use. Loop diuretics such as fioidum and bometanid are very potent and often used in acute settings like pulmonary edema or congestive heart failure. These medications remove large volumes of fluid quickly but they also strip the body of potassium leading to hypocalemia. Nurses must monitor electrolyte levels carefully and often administer potassium supplements concurrently. Thioide diuretics such as hydrochloroioide and chloraladone are frequently used for long-term blood pressure control. They are less potent than loop diuretics but can still cause hypocalemia as well as mild increases in blood sugar, uric acid and lipid levels. On the other hand, potassium sparing diuretics like spironolactone and a plurinone help the body retain potassium while promoting fluid excretion. These are often used in patients with heart failure or those at risk for low potassium levels. However, they carry the risk of hyperc calalemia especially when combined with ACE inhibitors or ARBs. As a rule of thumb, all diuretics should be given in the morning to prevent frequent nighttime urination. Nurses must monitor intake and output, daily weights, electrolytes, and renal function regularly to prevent complications. So to summarize where we are so far, ACE inhibitors and ARBs help regulate blood pressure by targeting the RHRS system. Beta blockers reduce cardiac workload by slowing the heart. Calcium channel blockers promote vasoddilation and in some cases slow the heart rhythm and diuretics eliminate excess fluid to reduce both blood pressure and cardiac strain. This ABCD approach gives us a comprehensive foundation for managing hypertension in many cardiovascular conditions. Now that we've covered the ABCDS of anti-hypertensives, we're going to continue our cardiovascular pharmarmacology discussion, let's begin with vasodilators. These medications function by directly dilating the arteries, which leads to a rapid reduction in blood pressure. because they decrease afterload the pressure the heart must work against to eject blood. They are particularly beneficial in managing conditions like heart failure where the heart is already struggling to pump effectively. Among the commonly used vesilators is nitroglycerin which is primarily used to manage acute chest pain or angina and is also helpful in cases of congestive heart failure. It's important for patients using nitroglycerin to be instructed on proper storage as it must be kept in a dark glass bottle to preserve its potency. Additionally, in an episode of chest pain, the patient may take one dose every 5 minutes up to a total of three doses. If the pain persists after the third dose, it is considered a medical emergency and requires immediate intervention. Another vasod diilator hydrolysine is used for managing hypertension and heart failure and is notable for being safe during pregnancy especially in cases of pregnancy induced hypertension. In contrast, sodium nitropide is a potent agent reserved for hypertensive emergencies. It is administered intravenously and requires careful monitoring due to the potential for cyanide toxicity. This rare but serious complication can present as confusion or signs of metabolic acidosis necessitating close observation and prompt discontinuation if toxicity is suspected. Common side effects associated with vasa dilators include hypotension due to the sudden drop in vascular resistance, reflex tacicardia as the body attempts to compensate for lowered blood pressure and symptoms such as dizziness, headache and fluid retention leading to edema. From a nursing perspective, it is essential to monitor the patients blood pressure very closely. In situations where reflex tacoc cardia develops, a beta blocker may be prescribed to help control the heart rate and mitigate the compensatory mechanism. These drugs work quickly and are often used in emergency settings where rapid blood pressure control is necessary, but their potency also demands heightened clinical vigilance. Moving on to anti-arithmic medications. These drugs are used to regulate abnormal heart rhythms, especially those that may be life-threatening. One of the most important agents in this class is amioderone, which is indicated for serious arhythmias such as ventricular fibrillation in ventricular tacicardia. Amiodorone exerts its effects by blocking potassium channels which prolongs the repolarization phase of the cardiac action potential. This delay slows the heart rate and stabilizes cardiac rhythm. However, while effective, amiodarone carries several serious adverse effects. One major concern is pulmonary toxicity which may present as a new onset of cough or shortness of breath. If these symptoms arise, the drug should be stopped immediately and the patient should be assessed for pulmonary complications. Additionally, amiodurone can cause liver toxicity. So, regular monitoring of liver function tests is warranted. It may also lead to visual disturbances such as corial deposits and thyroid dysfunction which can manifest as either hypothyroidism or hyperyroidism. Other anti-ythmics include lidocaine administered intravenously to manage ventricular arrhythmias and adenosine which is used to treat super ventricular tacocardia by temporarily slowing the heart rate. These drugs are typically administered in acute care settings under continuous monitoring due to their potent effects on cardiac rhythm. For more information about detailed cardiovascular medications such as anti-platelets, anti-coagulants, and doxin, check out our website for the full notes. Now, let's shift gear to respiratory medications. The primary goal is to open the airways, reduce inflammation, and ultimately improve oxygenation. These drugs are essential in managing conditions like asthma, COPD, emphyma and chronic bronchitis. Since airway obstruction is a hallmark of these diseases, the first step in treatment is almost always to restore air flow. And this is where bronco dilators come in. Bronco dilators are the frontline treatment in both asthma and COPD. Among them, short-acting beta 2 agonists or sabas are especially important because they provide rapid relief. These medications act on beta 2 receptors in the lungs, relaxing bronchial smooth muscle and opening up the airways almost immediately. Albuterol is the most commonly used SABA and it is the first medication we reach for during an acute asthma attack. That's a critical NLEX concept. If a patient is in distress, albuterol is the first line rescue. Leveluterol works similarly but is sometimes preferred in patients who experience too much tacicardia or jitteriness from aluterol. These medications have an onset of action between 5 to 15 minutes and their side effects include tacocardia, palpitations, tremors and occasionally hypocalemia. Restlessness and shakiness are also common and expected. Because of these side effects, it's essential to monitor the patients heart rate and potassium levels if used frequently. Despite their strong therapeutic benefit, Sabas are not meant for long-term control. They are quick relief or rescue inhalers only. For long-term maintenance, we turn to long acting beta 2 agonists or labas such as Salmetol and Formoterol. These drugs are used to maintain open airways over time, especially in patients with moderate to severe asthma or COPD. However, there's an important enclelex safety point to remember. Lavas should never be used alone in asthma treatment. Doing so increases the risk of asthma related death. They must always be prescribed in combination with an inhaled corticoststeroid. The reasoning behind this is that while labas open the airways, they do not address the underlying inflammation. Without an anti-inflammatory component, the airway remains vulnerable. Their side effect profile is similar to SABAS, including tacocardia, tremors, and palpitations. But because they are used daily, monitoring is less urgent unless symptoms worsen. Another category of broncoilators includes antiolinergic medications easily identified by the tropium suffix. These drugs work by blocking the parasympathetic nervous system which normally causes bronco constriction and stimulates mucous secretion. By blocking this response, anticolinergics relax the airways and reduce secretions. These are particularly beneficial in COPD management and are used for maintenance rather than rescue. Ipatropium is a short-acting anticolinergic often used alongside aluterol while tiatropium is long acting and taken once daily for ongoing soap de management. However, it's essential to remember that anticolinergics are not to be used in acute respiratory distress. They take time to work. One of the most common side effects of this class is dry mouth. Patients can manage this by sipping water or chewing sugar-free gum. Other side effects include blurry vision, constipation and urinary retention. Because of these effects, anticolinergics are contraindicated in patients with narrow angle glaucoma and benign prostatic hyperplasia. This is important to assess for before initiating therapy. Now while bronco dilators open the airways, they do not address inflammation which is a central feature in asthma. For that we use corticosteroids. These drugs come in two forms, inhaled and systemic. Inhaled corticosteroids or ICS are used daily for long-term control in both asthma and COPD. Common examples include fluicasson and buddhisenide. These drugs reduce airway inflammation and prevent exacerbations by decreasing swelling and mucus production in the bronkey. There are a couple of key administration principles that are testable on the enclelex. First, if a patient is using both a bronco dilator and an inhaled corticoststeroid, the bronco dilator should be used first. This opens up the airways and allows the steroid to reach deeper into the lungs. After using an IC, the patient should rinse their mouth thoroughly to prevent oral candidis, also known as thrush. This fungal infection is a common side effect due to the localized immune suppression from the steroid. Systemic corticosteroids such as prednosone taken orally and methyl prediniscolone given intravenously are used for severe asthma attacks or acute exacerbations of COPD. These are powerful anti-inflammatory agents but come with a significant side effect profile especially when used longterm. Patients may experience hypoglycemia, increased risk of infection, osteoporosis, mood changes including depression, fluid retention, and weight gain. These can be remembered with the six S's. Sugar, high glucose, soft bones, osteoporosis, sick, immunosuppression, SAD, mood changes, salt, fluid retention, and swollen, weight gain. It's also important to taper these medications slowly after prolonged use to avoid adrenal insufficiency which can be life-threatening. Next, we have the lucatrine modifiers such as montlucas, zaplucas and ziluton. These medications block the action of lucotrines, chemical mediators that cause inflammation, bronco constriction and mucus production. Montalucass in particular is widely used for asthma prevention and allergic rhinitis. It's taken orally and is particularly helpful in patients who have asthma triggered by allergens or exercise. This drug is taken in the evening as absorption and symptom control are generally better at that time. An important enclelex point is that Montilucast is not for acute asthma attacks. It is used strictly for prevention. Patients should also be monitored for changes in mood including depression and suicidal ideiation which have been reported in some individuals. While rare, this is serious and warrants immediate attention if symptoms arise. When mucus production becomes problematic, especially in chronic bronchitis or cystic fibrosis, mucalytics and expectctors are used to assist with clearance. A cetalcyine commonly known as mucamist is a mucalytic that breaks down the structure of thick mucus, making it easier to cough up. Interestingly, it is also the antidote for acetaminophen toxicity. Patients should be warned that it has a strong sulfur odor, often described as smelling like rotten eggs, which can be off-putting. Guyenisonin is anector that helps thin mucus, making coughs more productive. Adequate hydration is essential when using as water is needed to effectively thin the mucus. Both mucalytics and can cause gastrointestinal upset, so they are best taken with food. In cases of a dry non-productive cough, anti-tussives are used. These medications suppress the cough reflex and are generally reserved for nighttime use or situations where coughing interferes with rest. Dextroathorphan is a commonly used nonopioid antitusive found in many over-the-counter formulations. In high doses, it can cause hallucinations which is why it is sometimes misused recreationally. Codin on the other hand is an opioid antusive used for more severe cough because of its sedating properties and potential for respiratory depression. It must be used with caution. Antusives should never be used in cases of productive cough as suppressing the cough can trap mucus in the lungs and lead to complications like infection. This layered approach relieving bronco spasm reducing inflammation and supporting airway clearance is the foundation of respiratory pharmarmacology and critical knowledge for enclelex success. Let's now move into another cornerstone of pharmarmacology. Corticoststeroids. These medications are incredibly powerful and versatile. You'll encounter them often in respiratory, dermatologic, autoimmune, and endocrine conditions because they mimic cortisol, the body's natural steroid hormone produced by the adrenal cortex. Corticosteroids influence everything from metabolism to fluid balance, immune response, and stress adaptation. Corticosteroids are easy to spot because most of them end in zone or ID. For example, predinisone, methyl prednisolone, fluticosicosone, andide. We'll begin by breaking them down by route and purpose so you understand how they're used in clinical settings. First, we have inhaled corticosteroids, also called ICS. These are commonly prescribed for daily maintenance in asthma and COPD, helping to prevent airway inflammation and mucus production over time. Key examples include fluticosone, phlovent, and bistoonide pulmaort. These drugs are not meant to treat acute attacks but are essential for long-term control. In fact, inhaled corticosteroids are considered firstline therapy for persistent asthma. Nursing guidance here is crucial. If the patient is using both a bronco dilator like albuterol and an ICS, they must use the bronco dilator first. Wait about five minutes and then use the steroid inhaler. This allows the airways to open up so the steroid can penetrate more effectively. Also, patients should be instructed to rinse the mouth after inhalation to prevent oral thrush, a common complication due to localized immune suppression in the mouth. Second, let's look at oral and intravenous corticosteroids. These systemic steroids are reserved for more severe asthma exacerbations, COPD flares, autoimmune conditions, and inflammatory diseases. Common examples include predinisone, which is oral and methyl prediniscolone, which is IV. Because they enter systemic circulation, they carry a much higher risk of widespread side effects, which we'll discuss shortly. Third, we have nasal corticosteroids used primarily for seasonal allergies, nasal congestion and sinus inflammation. Examples include fluticosone, betainide, mdasone and triinolone. These medications should be used daily for best results and typically take one to two weeks to reach full effectiveness. Patients should blow their nose before use, spray away from the nasal septum, and avoid blowing the nose immediately afterward to allow for absorption and minimize irritation or nose bleeds. Fourth, we have topical corticosteroids often used for skin conditions like eczema, psoriasis, and allergic rashes. These come in various potencies. For example, hydrocortisone is a low potency over-the-counter cream, while triumphinolone is medium strength and clettool or betamethasone are high potency prescription options. These should always be applied in thin layers, never used on open wounds, and avoided on the face or sensitive areas unless prescribed for short-term use due to the risk of skin thinning and delayed wound healing. Now, let's talk about what happens with long-term use, especially with systemic corticosteroids. This is heavily tested on the enclelex because of the wide-ranging effects on nearly every organ system. You can remember these complications using the acronym steroid sugar increase. Corticosteroids raise blood glucose levels by increasing gluconneogenesis, putting patients at risk for hypoglycemia or even diabetes. T trunkal obesity. Long-term use leads to fat redistribution causing features like moonface, buffalo hump, and central weight gain. E electrolyte imbalances, specifically hypocalemia and fluid retention contributing to hypertension. Risk for infection. These drugs suppress the immune system making even minor infections potentially dangerous. O. Osteoporosis. Steroids impair calcium absorption and decrease bone formation leading to bone thinning and fracture risk. I insomnia and irritability. Patients often report mood swings, anxiety, and trouble sleeping. D. Delayed wound healing. Corticosteroids slow down collagen synthesis and can lead to easy bruising and poor tissue repair. There are several universal nursing responsibilities when managing patients on any type of corticoststeroid, especially systemic ones. Always monitor blood glucose levels, especially in diabetics or anyone on long-term therapy. Educate patients to take cortosteroids with food to reduce gastrointestinal irritation and prevent ulcers. Keep a close eye on signs of infection, remembering that fevers may be absent due to immune suppression. Instruct patients to never stop corticosteroids abruptly after prolonged use. They must be tapered gradually under provider supervision. For long-term users, monitor for signs of osteoporosis and consider calcium and vitamin D supplementation if appropriate. One of the most critical concepts on the ENLEX regarding corticosteroids is adrenal suppression and the potential for adrenal crisis. This occurs when a patient who's been on long-term corticosteroids stop suddenly. The adrenal glands, which have been suppressed during steroid therapy, cannot produce cortisol fast enough to meet the body's needs. Symptoms of adrenal crisis include severe hypotension, fatigue, weakness, shock, low blood sugar, and high potassium levels. This is a medical emergency and must be treated immediately with IV hydrocortisone solucortev and IV fluids to restore profusion and cortisol levels. Finally, let's briefly compare Addison's disease and Cushing syndrome focusing only on what's pharmacologically relevant. In Addison's disease, the adrenal glands don't produce enough cortisol, the treatment. We ADD steroids, specifically hydrocortisone and fludrocortisone. and patients will often need to increase the dose during times of stress to avoid crisis. In Cushing syndrome, the body has too much cortisol, usually due to long-term steroid therapy or indogenous overprouction. The solution here is usually to taper off the corticosteroids under supervision and manage the complications of excess cortisol. So, the takeaway is this. Low cortisol, think Addison, add steroids. High cortisol, think Cushings, cut back steroids. Now, let's talk about a high-risk, highreward group of medications. Anti-coagulants and anti-platelets. These drugs are used to prevent clots in conditions like stroke, DVT, pulmonary embolism, and atrial fibrillation. While they don't break down existing clots, they help stop clots from forming or getting bigger. The difference between the two is important. Anti-platelets prevent platelets from clumping together. They're used mostly to prevent arterial clots like in heart attacks or strokes. Anti-coagulants work deeper in the clotting process by slowing down clotting factors in the blood. They're used to prevent venus clots like in DBTs, pees or aphib. Let's start with anti-coagulants. Hepin is a fast acting anti-coagulant given intravenously or subcutaneously. It requires close monitoring of activated partial thromboplastin time levels which should be 1.5 to two times a normal value around 45 to 80 seconds. The antidote for heperin is protein sulfate. A serious complication is heperin induced thrombocytoenia a dangerous drop in platelets with increased clotting risk. Nooxaparin is a low molecular weight heperin given subcutaneously. It has a more stable effect and doesn't need a PTT monitoring. It also shares the same antidote protoamine sulfate. Warferin is a slow acting oral anticoagulant. It's monitored using the INR which should stay between two and three. The antidote is vitamin K and patients should eat a consistent amount of leafy greens to avoid sudden changes in vitamin K levels. Also, antibiotics can increase INR making bleeding more likely. Now let's look at antiplatlets. Aspirin irreversibly blocks platelets for 7 to 10 days, so it's held a week before surgery. It's used for heart attack and stroke prevention, but it can cause GI bleeding and tinidis, which is an early sign of toxicity. Clapitil also prevents platelet clumping and is commonly given after stent placement or for stroke prevention. Side effects include bleeding and bruising. So patients should report any signs like bloody gums, petici or dark stools. Now let's quickly touch on thrombolytics which are the only drugs that dissolve clots. They're used in emergencies only such as eskeemic stroke, massive PE or heart attack. Alttoplays TPA is the most common. It must be given within 3 to 4.5 hours of stroke symptoms. These drugs come with a high risk of bleeding, especially intraraanial hemorrhage. That's why they are not given to anyone with active bleeding, recent surgery, or a history of hemorrhagic stroke. Whether your patient is on an anti-coagulant, an anti-platelet, or a thrombolytic, always watch for signs of bleeding such as petiki, bruising, echimosis, blood in urine, hematia, black terry stools, melanina, nose bleeds or bleeding gums. If bleeding happens, stop the drug. Give the antidote if available and monitor vitals closely. A drop in blood pressure could mean internal bleeding. So to sum up, anticoagulants like heperin and morphine prevent venus clots. Antiplatlets like aspirin and plavix prevent arterial clots. Thrombolytics like tpa break down clots in emergencies. Pain is one of the most important and complex sensations we assess in nursing. It is not just a physical response but a subjective personal experience influenced by biological, psychological, and emotional factors. Understanding the different types of pain is essential for selecting the most appropriate treatment. We classify pain by duration, source, and mechanism. Acute pain comes on suddenly and is usually associated with a specific injury, surgical procedure, or illness. It tends to resolve as the underlying cause heals. In contrast, chronic pain persists for longer than 3 to six months and may be either constant as in arthritis or intermittent like migraines. Neuropathic pain is caused by nerve damage and is typically described as burning, tingling or shooting seen in conditions like diabetic neuropathy or phantom limb pain. On the other hand, no susceptive pain is related to tissue damage and can be sematic from skin, bones, muscles or visceral from internal organs. Patients often describe this type of pain as sharp throbbing or aching. Lastly, referred pain occurs when the sensation is felt in a different location from its origin, such as left arm pain during a heart attack. A thorough pain assessment helps determine the type, severity, and appropriate treatment. Nurses often use the PQRST method. P for provocation or paliation, what makes it better or worse. Q for quality, how the pain feels. R for region and radiation, where the pain is and whether it spreads. S for severity, using tools like the numeric rating scale or Wong Baker faces. A T for timing, when it started, how long it lasts, whether it's constant or intermittent. For infants and non-verbal patients, we use the FLACCC scale, which assesses facial expression, leg movement, activity, crying, and consolability. Non-farmacologic pain management can be very effective, especially when used in combination with medications. These approaches include cognitive behavioral techniques such as distraction and guided imagery, physical therapies like heat or cold applications, massage, acupuncture, and positioning to reduce discomfort. Interventions like music therapy and relaxation exercises are also valuable, particularly for patients with chronic or procedural pain. When it comes to medications, the first category we consider is opioids, which are reserved for moderate to severe pain. These medications work by binding to opioid receptors in the brain and spinal cord, blocking the perception of pain. Morphine is the gold standard used in many settings through I2V, oral, or patient controlled analesia, PCA. Fentinyl is a much stronger opioid about 100 times more potent than morphine and comes in patches, lozenes, and IV forms. Hydromemorphone is another strong opioid often used in surgical or cancer pain. Oxycodone is commonly prescribed after surgery and often combined with acetaminophen. Codin is a weaker opioid used in some cough syrups and for mild pain. Tramodol is a synthetic opioid used for moderate pain and has a lower abuse potential. While methadone and buprenorphine are used not only for chronic pain but also for treating opioid use disorder. Because of their powerful effects, opioids carry serious risks. The most critical is respiratory depression which can occur even at therapeutic doses especially in opioid nave patients. If a patient's respiratory rate drops below 12 per minute, the opioid should be held. Overdose symptoms include pinpoint pupils, unconsciousness, and slow breathing, a classic triad of opioid toxicity. In these cases, nlloxxone narcan is the antidote and can be administered intraasally inm or IV to rapidly reverse the effects. Additionally, patients on opioids often experience constipation due to slowed GI motility. So, stool softeners or laxatives should be routinely prescribed. Nurses should educate patients to avoid alcohol, bzzoazipines or any other CNS depressants while taking opioids due to the compounded risk of sedation and respiratory failure. For mild to moderate pain, we typically use nonopioid medications like NSAIDs and acetaminophen. NSAIDs, non-steroidal anti-inflammatory drugs, are particularly effective for pain associated with inflammation. Ibuprofen and neproxin are common over-the-counter options, while karolic is a potent NSAID often used after surgery, but limited to 5 days due to its GI and renal toxicity. Aspirin not only relieves pain, but also prevents clot formation when given in low doses daily. Celoxib, a KOX2 selective NSAID, provides similar pain relief with a reduced risk of GI irritation, making it a better option for long-term use. Despite their usefulness, NSAIDs come with significant risks. They can cause gastric ulcers and GI bleeding, especially in older adults or when taken without food. They may also impair renal function, particularly in patients with pre-existing kidney disease. So kidney function tests BUN creatinine must be monitored. NSAID are also contraindicated in pregnancy especially in the third trimester due to the risk of premature ductus arteriosis closure in the fetus and increased bleeding risk in the mother. Patients should stop taking NSAID before surgery to reduce the risk of intraoperative bleeding. Acetaminophen, Tylenol, is often considered the gentler pain reliever, but it also has serious risks when used improperly. It does not reduce inflammation, but it is effective for fever and mild pain and is generally safer for the stomach and kidneys. It's commonly found in combination drugs like Percoet or Vicodin paired with opioids for more comprehensive pain relief. However, it can be toxic to the liver in high doses. The maximum recommended dose is four grams per day or 3 grams per day in patients with liver disease. Overdose can result in acute liver failure and the antidote is acetylcyine which works by replenishing liver protective compounds. A key inclelex tip here, combining alcohol with acetaminophen significantly increases the risk of fatal liver damage. For specialized types of pain, particularly neuropathic or chronic pain, we use adgivant analesics. These are not primary pain medications but are used to enhance pain relief in specific conditions. For example, gabapentine and pabalan are anti-convulsants commonly prescribed for nerve pain and fibromyalgia. They work by calming overactive nerve signaling. Anti-depressants like amatryptylin, delloxitine andaxine are used for chronic pain particularly in diabetic neuropathy and fibromyalgia and they modulate neurotransmitters involved in pain perception. Muscle relaxants including bloen and cyclloensziprne help relieve pain from muscle tension or spasticity. Finally, corticosteroids such as predinisone and dexamethasone are often used for inflammatory pain related to cancer, arthritis, or autoimmune diseases. While effective, these medications carry risks of drowsiness, mood changes, and metabolic side effects. For anti-depressants in particular, gradual tapering is essential to avoid withdrawal symptoms like irritability, dizziness, or flu-l like discomfort. In procedural and surgical settings, we rely on local and general anesthetics. Local anesthetics like lidocaine are used to numb a specific area either topically or through injection. Patches and creams like EMLA are commonly used before needle procedures or minor skin interventions. Bye and rupeca are longer acting agents often used in epidurals or nerve blocks. General anesthetics such as propal, ketamine, and nitrous oxide induce unconsciousness for surgeries or procedures. Propal known for its fast onset and offset requires careful monitoring due to risks of hypotension and respiratory depression. Ketamine which provides dissociative anesthesia is unique in that it preserves airway reflexes and can also be used in chronic pain management. Nitrous oxide, commonly used in dental procedures, provides light sedation and pain relief with minimal systemic effects. Throughout all categories of pain medications, nursing responsibilities are critical in preventing complications. Nurses must be able to recognize life-threatening adverse effects, especially with opioids. The classic signs of opioid overdose, slow breathing, pinpoint pupils, and unconsciousness, require immediate action with Nlloxxone. With NSAIDs, the biggest concerns are GI bleeding and renal impairment. And with acetaminophen, liver toxicity is the primary danger, particularly when combined with alcohol. Understanding these risks and educating patients on safe medication practices is a key nursing role and a frequent ENLEX test point. In summary, pain management is not one-sizefits-all. It requires accurate assessment, knowledge of medication mechanisms, careful monitoring, and thoughtful patient education. Whether using nonopioids, opioids, adgiants, or anesthetics, the nurse's role in ensuring safe, effective pain control is central to both healing and Okay, based on today's lecture, let's practice some enclelex type questions. Question one. A client recently started on Linopril for heart failure and calls the clinic complaining of a persistent dry cough. What is the nurse's best response? The correct answer is we'll notify your provider you may be switched to another medication. Rationale. A dry persistent cough is a well-known side effect of ACE inhibitors like leinopril. It's caused by increased levels of bredikinan and is not dangerous but it can be bothersome enough that the provider might choose to switch the patient to an ARB like losartin. It's not a reason to rush to the emergency room unless there are signs of angiodma and telling the client to just continue taking it is not appropriate without discussing it with the provider. Question two. The nurse is reviewing lab results for a client on long-term methyl printed nylon therapy. Which finding is most expected? The correct answer is elevated blood glucose and low potassium. Rationale: Systemic corticosteroids, especially when used long-term, commonly cause hypoglycemia by increasing glucanogenesis and they may lead to hypocalemia due to fluid shifts in renal effects. These are expected findings. While corticosteroids also affect the immune system, white blood cell counts are typically elevated, not decreased due to demargation and low blood glucose would be unexpected in this context. Question three. A client receiving intravenous heperin suddenly develops a platelet count of 90,000 and complains of leg pain. What is the nurse's priority action? The correct answer is notify the provider immediately. Rationale. A sudden drop in platelet count combined with signs of new clot formation like leg pain suggests heperin induced thrombocytoenia aishit. This is a serious complication that increases the risk for thrombotic events. The priority is to stop the hepin and notify the provider so the patient can be evaluated and switch to a non- hepepin anticoagulant. Prodamine sulfate is used for active bleeding, not for hut. And vitamin K is used for warfarin, not heperin. Question four. A client prescribed epotropium reports a dry mouth. What is the nurse's most appropriate response? The correct answer is this is a common side effect. Try chewing sugar-free gum or sipping water. Rationale: Epotropium is an antiolineric bronco diilator and dry mouth is one of its most common side effects. This is not an allergic reaction and it doesn't require stopping the medication. Instead, we manage it with comfort measures like sugar-free gum or frequent sips of water. Rinsing the mouth is essential for inhaled corticosteroids, not antiolinerics. and grapefruit juice has no role here. Question five. A nurse is preparing to administer IV keterolic to a posttop patient. What is the most appropriate action before giving the drug? The correct answer is assess the client's kidney function before administration. Rationale: Karlac is a potent NSA that can be nephrotoxic, especially if used for longer than 5 days. Before administering, the nurse should check the client's kidney function, including BUN and creatinine levels. The drug should always be taken with food or fluids to minimize gastrointestinal side effects. While it may sometimes be combined with opioids, that's a provider decision, not a nursing priority. And continuing it beyond 5 days is unsafe. All right, that wraps up part two of our pharmarmacology enclelex lecture series. If this helped you out, don't forget to subscribe, like, and hit the notification bell so you don't miss part three and all the other good stuff coming your way. And if you're looking for the detailed pharmarmacology guide notes from this lecture, head over to our website, your nursingspace.com. You'll find in-depth lecture notes, enclelex specific resources, and more tools to help you pass with confidence. You can also check out our test bank platform, Exam ASAP, our advanced adaptive testing platform, featuring over 5,000 peer-reviewed questions designed to mirror the INLEX experience. It includes detailed ration, daily content updates, and a 247 AI tutor resources recognized as industry-leading and proven to enhance your performance. Not only that, our question bank platform has next generation enclelex question types with case studies. We are adaptive and AI powered platform that allows you to pass the enclelex the first try. With our question bank platform, you are able to see the analysis of how ready you are for the ENCLEX exam with a detailed analysis based on your performance. So check out our website for all those goodies. And I hope this lecture helped you feel a bit more confident with the pharmarmacology section, whether you're studying for nursing school or gearing up for the ENCLEX. Again, I'm Mark Johnson, your ENCLEX instructor here at YNS, and I'll see you in the next lecture. [Music] [Music] Welcome to part three of our ENCLEX pharmarmacology lecture series. If you haven't had the chance to watch parts one and two yet, I highly recommend starting there first. Those lessons lay the groundwork with key concepts that will make today's material much easier to follow. My name is Mark Johnson. I'm an ICU nurse and your ENLEX instructor here at YNS. In this lecture, we're diving deeper into pharmarmacology. This time, breaking it down by body systems so it's easier to understand and apply. Today, we're starting with a big one, endocrine system medications. And if you want to follow along this lecture with the detailed and visual notes, check out our pharmarmacology mastery notes on our website, your nursingspace.com. Without further ado, let's start with endocrine medications. The endocrine system controls some of the body's most essential functions including blood sugar regulation, metabolism, fluid balance, growth, and reproductive health. So naturally, medications in this system target conditions like diabetes, thyroid disorders, adrenal dysfunction, and pituitary imbalances. Let's break this down system by system. Starting with thyroid medications, we'll begin with hypothyroidism. That's low T3 and T4 and high TSH. The medication of choice is levothyroxine, a synthetic T4 that the body converts to T3. It's used for both hypothyroidism and mixed coma. Key points. Take it in the morning on an empty stomach at least 30 to 60 minutes before food. Avoid calcium, iron or antacids which reduce absorption. It takes several weeks to see full effects and TSH is monitored to adjust dosage. This is lifelong therapy so don't stop it abruptly. If the dose is too high, look for signs of hyperyroidism, teacardia, insomnia, weight loss, heat intolerance. Think levo, lifelong empty stomach, very active if overdosed. Other meds interfere. On the other hand, hyperthyroidism means high T3 and T4 and low TSH. It's treated with methamosole or propilerosil PTU. These drugs block thyroid hormone production and are used in Graves disease or thyroid storm. PTU is used in pregnancy while methamole is generally preferred otherwise. Watch for agronuloccytosis. Signs include fever and sore throat and hepidtoxicity. Also monitor for signs of hypothyroidism if the dose is too strong. Take with food to avoid GI upset and avoid iron or antacids. Remember PTU puts the thyroid underground. It suppresses thyroid hormone levels. Let's shift to blood sugar management. Starting with hypoglycemia, low blood sugar. It shows up with signs like sweating, cold and clammy skin, shakiness, confusion, and irritability. If the patient is conscious, we follow the rule of 15. Give 15 g of a fast acting carbohydrate, juice, glucose tabs, or honey. Then recheck blood sugar in 15 minutes. If it's still low, repeat. Once stable, follow up with a complex carb and protein combo like peanut butter and crackers to maintain blood sugar. If the patient is unconscious, the first choice in the hospital is IVD50, dextrose 50%. At home, we give IM glucagon. Since glucagon can cause vomiting, turn the patient on their side to prevent aspiration. Now, let's look at hypoglycemia, which you'll recognize with the three Ps. Polyura, polyypsia, and polyphasia, plus signs like hot dry skin, blurred vision, fatigue, and in more severe cases, fruity breath, and cusmol respirations. These are hallmark signs of diabetic ketoacidosis, DKA. Treatment for hypoglycemia includes administering insulin, especially introvenous insulin for diabetic ketoacidosis while monitoring potassium closely since insulin drives potassium into cells. We also encourage hydration, monitor blood glucose levels frequently, and assess for urinary ketones. Long-term management includes educating patients about carbohydrate consistency and medication adherence. A good way to remember cold and clammy need some candy for hypoglycemia, hot and dry, sugars high for hypoglycemia. Now, let's get into insulin. For the inclicks, you need to know the onset, peak, and duration of the main types. Rapid acting insulins like lispro and aspart kicking fast about 15 minutes and peak around 1 hour. They should be given right at meal time to avoid hypoglycemia. Short acting insulin like regular insulin has a slower onset and a peak around 2 to four hours. Intermediate acting such as NPH takes a few hours to start and peaks around 6 to 12 hours. And long acting insulins like largene or detamir have no real peak and lasts over 24 hours. Always draw up regular clear insulin before NPH cloudy if you're mixing. And remember long acting insulins should never be mixed with other types. Rotate injection sites and always monitor for hypoglycemia especially during peak times. For type 2 diabetes, the first line oral med is metformin. It works by reducing glucose production in the liver and making the body more sensitive to insulin. It's usually well tolerated, but we hold it before contrast diet procedures because of the risk for lactic acidosis. We also monitor kidney function and if the creatinine is above 1.3 we stop the med. It should be taken with food to reduce stomach upset. Sulfanyluras like glyphoside and glyoride help the pancreas release more insulin but they carry a higher risk of hypoglycemia especially if a patient skips meals. They can also cause weight gain and alcohol should be avoided because it can trigger severe hypoglycemia. Then we have DPP4 inhibitors like citagly lilyin. These are gentler and often used in older adults but they come with a risk of pancreatitis. So any report of severe abdominal pain should be taken seriously. For diabetes incipitus we use desmopressin or ddavp which is a synthetic ADH. It helps the kidneys retain water. So we know it's working when urine output decreases. But too much can cause water intoxication leading to hyponetriia and confusion. So we keep a close eye on sodium levels. For growth hormone deficiency, we use somatropen which helps stimulate growth but can raise blood sugar. So we monitor for hypoglycemia during treatment. And finally for osteoporosis we have bisphosphinates like alendinate. These drugs help prevent bone breakdown and increase bone density, but they need to be taken first thing in the morning on an empty stomach with a full glass of water and the patient must stay upright for at least 30 minutes after taking it to avoid esophageal irritation. We also monitor calcium and vitamin D levels during therapy to make sure the bones are getting what they need. When it comes to gastrointestinal medications, we focus on managing a range of conditions. Everything from acid reflux and ulcers to nausea, constipation, and diarrhea. These are some of the most frequently encountered issues in clinical practice. And understanding how each class of medication works along with its side effects and nursing implications is key to safe and effective patient care. Let's start with acid reducers which are used to manage conditions like gird, peptic ulcers, gastritis, and heartburn. There are three main categories of acid reducing drugs. Proton pump inhibitors, PPIs, H2 receptor blockers, and antacids. Each with its own level of potency and use case. Proton pump inhibitors easily recognized by the prisole suffix are the most potent acid reducers. These include medications like omipresole, pantoresole, eomiprazole and lanzoprazole. They work by irreversibly blocking the proton pumps in the stomach lining which are responsible for producing hydrochloric acid. Because these pumps are the final step in acid secretion, PPIs are extremely effective making them firstline treatment for severe GED, erosive esophagitis and ulcer prevention, especially in patients taking NSAIDs. However, this potency comes with risks. PPIs must be taken on an empty stomach, typically in the morning, because food can reduce their absorption. Long-term use is associated with decreased calcium absorption, which increases the risk of osteoporosis and fractures. Additionally, by lowering stomach acid levels, these drugs may increase the risk of ced difficil infection since acid normally helps kill ingested bacteria. H2 receptor blockers such as fomotine, reanitine, withdrawn due to safety concerns, and simotidine are milder acid reducers. They work by blocking histamine receptors in the stomach lining, which suppresses acid secretion. Although not as strong as PP is, H2 blockers are often safer for long-term use and are still widely used for less severe GED or ulcer prevention. They can be taken with food which makes them convenient and they are less likely to impair kidney function than PPIs. However, simotidine should generally be avoided in the elderly due to its risk of confusion, gynecomastia and drug interactions. Antacids such as magnesium hydroxide, milk of magnesia, calcium carbonate, Tums, aluminum hydroxide and sodium bicarbonate act differently. Instead of blocking acid production, they work by neutralizing existing stomach acid, increasing the pH, and providing quick relief from heartburn or indigestion. These are the fastest acting, but also the least potent and are generally used for short-term symptom relief. It's important to administer antacids 1 to 3 hours after meals and at bedtime, and to avoid giving them simultaneously with other medications as they may interfere with absorption. Also keep in mind that magnesium based antacids can cause diarrhea while aluminum based antacids can cause constipation. So sometimes a combination product is used to balance these effects. Now moving on to laxatives which are used to relieve constipation. A common side effect of many medications including opioids and a frequent concern in post-operative care. There are four main types. Bulk forming stimulant osmotic and stool softeners. Bulk forming laxatives such as selium and methyl cellulose are considered the safest long-term option. They mimic natural dietary fiber absorbing water and expanding in the intestines to form a soft bulky stool that is easier to pass. These medications are not fast acting and must be taken with plenty of water to prevent intestinal obstruction. Stimulant laxatives including biscottle and senna are the fastest acting but also the most aggressive. They directly stimulate the nerves in the intestinal wall causing contraction and rapid evacuation. While effective for short-term relief, these should not be used daily as long-term use can lead to dependence and electrolyte imbalances and may damage the entic nervous system. Osmotic laxatives like milk of magnesia, lactalose, polyethylene glycol, mirilax and magnesium citrate work by drawing water into the intestines which softens stool and promotes paristalsis. These can be very effective but may cause dehydration and electrolyte disturbances especially in older adults or those with renal issues. One important point, lactulose is not only a laxative but also used in patients with liver disease, especially cerosis because it reduces serum ammonia levels by promoting ammonia excretion through the stool. Stool softeners such as docusate sodium do not stimulate the bowel or draw in fluid, but simply add moisture to the stool, making it easier to pass. These are often used postoperatively or in patients on opioids where straining is either painful or contraindicated. Shifting to the other end of the GI spectrum, let's discuss antidarals. These medications reduce bowel motility and help manage fluid loss, but they must be used cautiously. Lupramide amodium is a common over-the-counter antid-diarral that slows gut motility and allows for more water absorption in the colon. Bismouth subsalicellate Pepto-Bismol provides antimicrobial action and coats the stomach lining but contains aspirin so it must be avoided in children due to the risk of raise syndrome. Definoxilate atropene lomatil is a prescription opioid-based antidaral and while effective it carries a risk of CNS effects and dependency especially if misused. Importantly, antid-diarrals should not be used in infectious diarrhea such as cediffs or foodborne illness because slowing motility can trap pathogens in the GI tract and worsen the infection. Nurses should monitor for dehydration, electrolyte loss, and ensure fluid replacement as needed. Now, let's turn to antiimetics, which are used to treat nausea and vomiting. Common symptoms after surgery, during chemotherapy or with motion sickness. Dopamine antagonists include prochloroparazine, proathazine, and metacopramide. These medications work by blocking dopamine receptors in the brain, reducing the nausea c center's activity. They are effective but not without side effects. For example, meloppide can cause tardive diskynesia, which is a serious and potentially irreversible condition involving involuntary facial and body movements. This risk increases with long-term use, especially in older adults. Serotonin antagonists such asron, grenicetron, and palonocatron are considered the gold standard for chemotherapy induced nausea and vomiting. They are also used postoperatively and during pregnancy. The main concern with this class is QT interval prolongation which can lead to dangerous arhythmias. So cardiac monitoring may be necessary particularly in those with cardiac history or on other QT prolonging drugs. Finally, antihistamines such as dipenhydramine, mechazine, diminhydrron and hydroxazine are used for motion sickness and vertigo. These drugs work by blocking histamine receptors in the brain's vestibular system, but they commonly cause sedation and drowsiness. Patients should be cautioned against driving or operating machinery after taking these medications. Let's dive into one of the most high yield topics in pharmarmacology, antibiotics and antimicrobials. These medications are essential tools in treating bacterial infections, but they also come with specific risks, interactions, and testable details you'll need to know for the inclelex. Let's start with penicillins. These are the original antibiotics most easily recognized by the sillin ending. They are bacterasidal, meaning they work by destroying the bacterial cell wall. Penicillins are particularly effective against gram positive bacteria such as streptocous, stflocus, syphilis and menitis. Some common examples include emoxicylin and ampeoin which are often used for ear infections, strep throat and pneumonia. Penicellin G and penicellin V are typically used to treat a strep infections and syphilis. Hyperacillin combined with tazabactum better known as zosin is a broader spectrum penicellin that also covers tough to treat pathogens like pseudomonus. One of the most important concepts to understand about antibiotics especially penicillans is resistance. These drugs can be life-saving but only when used appropriately. That means the full course must be completed even if the patient feels better to avoid resistance and super infections. Patients must be monitored closely for allergic reactions, which can range from mild rash to life-threatening anaphilaxis. Always assess kidney and liver function since these organs are responsible for metabolizing and excreting most antibiotics. Also, check for potential drug interactions, especially with other nephrotoxic agents. A few high yield reminders apply to all antibiotics. First, always assess for allergies. This is an enclelex favorite. There's also a known cross- sensitivity between penicillins and sephilosporins which we'll talk about in a moment. Most antibiotics carry the risk of causing super infections such as cadiff thrush or vaginal yeast infections. Many antibiotics are best taken on an empty stomach typically 1 hour before or 2 hours after meals and some can reduce the effectiveness of oral contraceptives. Anaphilaxis is another favorite test topic. So remember the sequence. Stop the drug immediately. call the provider and administer epinephrine. Now let's move on to sephilosporins which are structurally and functionally similar to penicillans. These drugs typically start with CF or sephs and are grouped into generations from first through fifth with increasing spectrum of activity. Like penicillins, they are bacterasidal and work by weakening the bacterial cell wall. Common examples include sephylexin a first generation sephilosporin used for skin infections and UTI. Sephrioxone a third generation drug is used for more serious infections like menitis and gorrhea. Sephopime a fourth generation agent is frequently used in hospitalacquired infections including pseudomonus. For the enclelex, it's important to remember that sephilosporins have a known cross sensitivity with penicillins. So allergy history is critical. Patients should avoid alcohol while taking sephilosporins due to the risk of a dissolvike reaction which causes nausea, vomiting and abdominal cramping. Renal function should be closely monitored especially in older adults. Sephosporins can also increase bleeding risk. So if the patient is on warin their INR should be monitored. Next we have the macrolytes which end in throycin. These drugs are commonly used for respiratory infections, chlamyia and whooping cough. They are bacterioatic meaning they inhibit bacterial protein synthesis. A zithramycin commonly known as the zpac is a popular choice for outpatient infections. Clarithroycin is often used in the treatment of H palori and ariththramycin is a good alternative for patients with penicellin allergies. Key enclelex points include QT prolongation which is a known side effect of macrolytes. Always monitor ECGs especially if the patient is on other cardiac medications. Macrolytes are also hepotoxic so liver enzymes should be checked regularly. They should not be taken with statins due to the risk of rabdomiolysis. Some patients may experience a metallic taste or nausea which can be reduced by taking the medication with food. Let's move on to the floricquinolones which end in fluxassin. These are considered the big guns in the antibiotic world. They are bacterasidal and work by inhibiting bacterial DNA synthesis. They're used for serious infections including UTI, pneumonia, and gastrointestinal infections. Common fuoricquinolones include cyproloxicin used for UTI and even anthrax exposure and levofluxisonin which is effective for pneumonia and sinusitis. Fluoroquinolones come with a black box warning for tendon rupture. This risk is especially high in older adults, athletes, children and pregnant patients. Other side effects include photosensitivity. So patients must be advised to wear sunscreen and avoid tanning and central nervous system effects like confusion and seizures. These drugs should not be taken with dairy, antacids or iron as these substances interfere with absorption. A key teaching point is to report any heel or leg pain immediately as this could be an early sign of tendon damage. Now let's talk about the tetracycans which end in cycline. These drugs are bacterioatic and also work by inhibiting protein synthesis. Doxycycline is commonly used for MRSA and Lyme disease. While tetracycline is often prescribed for acne and H pylori. Tetrayclan should never be given to children under the age of eight as they can cause permanent tooth discoloration. They are also contraindicated in pregnancy due to their effects on fetal bone and tooth development. These drugs should not be taken with dairy products, iron or antacids. Space these substances at least 2 hours before or after taking the antibiotic. Tetracycans can cause photosensitivity and increase the risk of esophagitis. So patients should remain upright for at least 30 minutes after taking the medication. Next we have the amoglycosides which typically end in mcin and are administered intravenously. These are ICU level antibiotics used for severe infections such as sepsis and drugresistant organisms. Neomy is the exception and may be given orally for bowel sterilization before surgery. These drugs carry serious risks. There's a black box warning for both autotoxicity characterized by tenitis and hearing loss and nephrotoxicity. So renal function must be monitored closely. Peak and trough levels should be measured to ensure therapeutic levels without toxicity. These drugs are never given orally with the exception of neomy. Lastly, let's cover the sulonomides easily identified by the sulfa prefix. These drugs are bacterioatic and work by blocking folic acid synthesis. A commonly used example is sulfamethoxazole trimethopram or bactrum which is used for UTI, MRSA and pneumonia in imunocmpromised patients. Patients must be advised to drink plenty of fluids at least 2 to three liters per day to prevent kidney crystals. Sulphonomides can cause photosensitivity and may lead to Stevens Johnson syndrome, a rare but life-threatening rash that must be reported immediately. These medications can also raise potassium levels, so potassium supplements should be avoided. Sulphonomides are contraindicated in patients with sulfa allergies and during pregnancy. Let's move on to the emergency and critical care medications. Let's talk about some code blue medications. First up is epinephrine, the number one drug used in a code. It's given during cardiac arrest rhythms like VIB, pulseless VTAC, asyla. It stimulates both alpha and beta receptors, increasing heart rate, blood pressure, and overall perfusion. We give it every 3 to 5 minutes during CPR. It's also used IM for anaphilaxis with IV dosing if the reaction is severe. Watch for tacocardia, hypertension and palpitations once circulation returns. Next is atropene used for brady cardia especially if the heart rate drops below 40 beats per minute. It's an antiolineric that blocks vag nerve stimulation to raise the heart rate. We also use it in organo phosphate poisoning and sometimes before surgery to dry secretions. Be on the lookout for dry mouth, blurred vision and urinary retention and avoided in patients with glaucoma. Now let's talk about amiodarone. This is your go-to antiarithmic for ventricular arhythmias especially vtac and vib after an MI. It slows down conduction by blocking potassium channels, helping stabilize the rhythm. But it comes with serious risks. Pulmonary toxicity, thyroid issues, liver damage, and QT prolongation. So we monitor lung function, liver enzymes, and the QT interval closely. If amiodarone isn't available, lidocaine is a backup. It works by blocking sodium channels which slows down electrical conduction in the ventricles. It's helpful in vash and vib but not used for atrial arhythmias. Now let's shift into shock management. When a patient is in septic, hypoalmic or cardiogenic shock and fluids alone don't work. We reach for vasopressors to raise blood pressure and improve profusion. No epapinephrine also called levoped is the first line basopressor for septic shock. It causes strong basal constriction which raises BP quickly but it can also cut off circulation to the skin and extremities. So it must be given through a central line to avoid tissue damage. We detrate the dose based on the patients blood pressure and watch for signs of poor profusion like cool or modeled skin. Dopamine has dose dependent effects. At low doses, it improves kidney profusion. At moderate doses, it raises heart rate and blood pressure. And at higher doses, it strengthens the heartbeat, making it useful in cardiogenic shock or heart failure. But it's not used in hypoalmic shock and it can cause tacocardia. So we monitor vitals closely. Debutamine is more focused on improving cardiac output by helping the heart pump more effectively. It doesn't significantly raise blood pressure, but it's helpful in patients with low cardiac output like those in heart failure. It can also cause increased heart rate. So again, we keep an eye on vitals. Let's finish with respiratory crisis medications. Starting with the rescue inhaler everyone knows, aluterol. It's a fast acting beta 2 agonist that relaxes airway smooth muscle and opens the lungs during asthma attacks or COPD exacerbations. It can cause tremors and tacicardia especially if used in high doses. Always use albuterol before inhaled steroids so the airways open for better absorption. We often combine aluterol with hippotropium an antiolinergic bronco dilator. It's not a rescue med, but it works well in COPD and severe asthma, especially in combo inhalers like DuoB. Ipatropium can cause dry mouth and urinary retention, so monitor for those side effects. Then there's magnesium sulfate, which we use when an asthma attack isn't responding to usual treatments. It works by relaxing the bronchial muscles. It's also a key drug in preeclampsia to prevent seizures, but it can suppress the nervous system. So, we monitor for respiratory depression, loss of reflexes, and other signs of toxicity. If needed, we reverse it with calcium gluconate. Psychotropic medications are essential in treating mental health conditions like depression, anxiety, bipolar disorder, and psychosis. These drugs work by affecting neurotransmitters, primarily serotonin, dopamine, and norepinephrine to stabilize mood, reduce anxiety, and manage symptoms like hallucinations or mania. Let's begin with anti-depressants, which include four major classes. SSRIs, SNRIs, TCAs, and MAIs. SSRIs such as fluoxitine, certraline and acetylopreg are the firstline treatment for depression and anxiety. They increase serotonin levels and typically take four to 6 weeks to become effective. Patients must be monitored for worsening depression during the initial phase and for serotonin syndrome which can be life-threatening. Selective serotonin reuptake inhibitors should not be combined with St. John's warts or traumadol. If SSRIs are ineffective, SNRIs like benlaxine and delloxitine are often used. These increase both serotonin and norepinephrine and are especially helpful for nerve pain. However, they can increase blood pressure and sudden discontinuation may cause withdrawal symptoms such as dizziness or brain zaps. TCAs such as amatipptaline are older anti-depressants now more commonly used for neuropathic pain and migraines. They carry antiolineric side effects and have a high overdose risk making them less ideal for patients at risk of self harm. MAIs like fineline and trrencypine are last resort medications due to their serious food and drug interactions. They require strict avoidance of tyramine rich foods to prevent hypertensive crisis and a two-eek wash out period before switching to or from other anti-depressants. Now for anti-csychotics used in schizophrenia, bipolar disorder and psychotic depression, typical antiscychotics like block dopamine strongly and have a high risk of extraparamidal symptoms EPS and neurolleptic malignant syndrome NMS. A medical emergency involving fever and muscle rigidity. Atypical antiscychotics like resperadone and cloopine have a lower EPS risk but are linked to metabolic side effects such as weight gain, diabetes and dysipidemia. Clausipine specifically requires weekly WBC monitoring due to the risk of adrenalytosis. For bipolar disorder, the gold standard treatment is lithium which requires close monitoring. The therapeutic range is 0.6 6 to 1.2 mill equivalents per liter. Levels above 1.5 mill equivalents per liter are toxic with signs like tremors and confusion. Patients must maintain normal sodium levels and stay well hydrated as low sodium or dehydration increases toxicity risk. Valproic acid, another mood stabilizer and anti-vulsant, is used for bipolar disorder, seizures and migraines. It carries risk of liver damage, low platelets, and pancreatitis. So, monitoring LFTs and platelet counts is essential. Taking it with food helps reduce GI side effects. In short, psychotropic medications are highly effective, but come with serious risks. Safe administration requires understanding each drug class, recognizing red flags like serotonin syndrome or lithium toxicity, and educating patients about side effects, interactions, and the importance of adherence. The last topic of the lecture is reproductive and generinary medications. We'll start with oral contraceptives used not just for preventing pregnancy but also for regulating menstrual cycles, treating PCOS, managing indometriosis and improving acne. Combination pills contain estrogen and progesterine. Common examples include orthotric, yas, and season. A major enclelex concern is increased clot risk, especially in smokers, patients over 35, and those with obesity. Patients should never smoke while on these medications. They're contraindicated in breast cancer, liver disease, migraines with aura, and uncontrolled hypertension. Mist pills should be taken as soon as remembered, but two or more missed doses require backup contraception. For patients who can't take estrogen, like those breastfeeding or at high risk for clots, progesterine only pills are a safer option. These must be taken at the same time daily. A delay of more than 3 hours means backup contraception is needed. Emergency contraception such as Plan B or Ella works by delaying ovulation and must be taken as soon as possible. Most effective within 72 hours. These are not abortion pills and may cause cramping, nausea or irregular bleeding. Now on to erectile dysfunction medications which end in ail and include seldinophil, viagra, tatalophil and vardinophil. These are pde inhibitors that improve blood flow for erection. They are also used for pulmonary hypertension in some cases. A key enclelex warning, do not combine these with nitrates as it can cause fatal hypertension. Use caution in patients with heart disease. Side effects include flushing, headache, and priapism, which is an emergency if it lasts over 4 hours. Next, let's look at BPH medications. Alpha blockers like tamsyloin relax the prostate and bladder neck to improve urine flow. They can cause orthostatic hypotension. So patients should change position slowly and take the medication at bedtime to avoid falls. The second BPH treatment class is the five alpha reductase inhibitors such as finasteride and dutisteride. These shrink the prostate over months not days. They are teroggenic. Pregnant women should avoid touching crushed pills. These meds can also cause decreased libido or erectile dysfunction. In summary, focus on clot risks with estrogen, strict timing for minipills, dangerous interactions with ED drugs, and the slow onset of BPH medications. Know the safety teaching points, and you'll be ready for anything NLEX throws at you. Lastly, our pharmarmacology lecture notes wrap up with some important miscellaneous content, including antidote charts, high alert medications, toxic drug level charts, and 50 enclelex style practice questions with detailed answers, all shown here. But for the sake of time, we'll be skipping this section in the video. You're more than welcome to review those detailed notes anytime on our website. Now that we've covered the majority of the high yield pharmarmacology topics from the notes, let's move on to practicing some enclelex style questions together. First up, a client with asthma receives multiple doses of aluterol during an acute exacerbation. Which assessment finding should the nurse expect? The answer is tremors and tacocardia. The rationale is that albuterol while primarily a beta 2 agonist can also mildly stimulate beta 1 receptors especially at high or repeated doses. This results in increased heart rate and muscle tremors which are common and expected side effects. Brady cardia, drowsiness, and respiratory depression are not typical with albuterol use. Next, the nurse is educating a client on lithium therapy. Which statement by the client indicates the need for further teaching? The answer is it's okay to take ibuprofen daily for my back pain. The rationale is that NSAs like ibuprofen can interfere with renal clearance of lithium leading to a higher risk of toxicity. Clients on lithium should avoid NSAIDs unless their provider specifically approves it. All the other statements reflect good understanding of hydration, toxicity symptoms, and the importance of routine blood level monitoring. A nurse is caring for a client on Clausopine for treatment resistant schizophrenia. Which of the following assessments is the priority? The answer is white blood cell count. The rationale is that clausipine carries a high risk of a granolatosis, a potentially life-threatening drop in WBC's. That's why weekly or bi-weekly blood monitoring is required, especially early in therapy. While weight gain and metabolic effects are relevant, infection due to low neutrfils is the most urgent concern and takes priority. Next, a client with hypothyroidism is prescribed leviththroxin. Which of the following instructions should the nurse include? The answer is take the medication in the morning on an empty stomach. The rationale is that levothyroxine is best absorbed without food. Ideally taken 30 to 60 minutes before breakfast. It also needs to be taken consistently each day and clients should understand that improvement takes weeks not hours. It's a lifelong therapy and should not be stopped abruptly even if symptoms improve. Which finding in a client receiving IV magnesium sulfate for preeacclampsia requires immediate intervention? The answer is absent deep tendon reflexes. The rationale is that loss of reflexes is an early indicator of magnesium toxicity which can progress to respiratory depression and cardiac arrest if not addressed. This is a medical emergency. The infusion should be stopped and calcium gluconate the antidote should be prepared. Mild flushing and elevated BP are expected findings in preeclampsia and urine output of 35 ml per hour is still within acceptable range. All right, that was it for the pharmarmacology mastery lecture series. If this helped you out, don't forget to subscribe, like, and hit the notification bell so you don't miss part three and all the other good stuff coming your way. And if you're looking for the detailed pharmarmacology guide notes from this lecture, head over to our website, your nursingspace.com. You'll find in-depth lecture notes, enclelex specific resources, and more tools to help you pass with confidence. for the pharmarmacology mastery lecture series. If this helped you out, don't forget to subscribe, like, and hit the notification bell so you don't miss any new videos and all the other good stuff coming your way. And if you're looking for the detailed pharmarmacology guide notes from this lecture, head over to our website, your nursingspace.com. You'll find in-depth lecture notes, enclelex specific resources, and more tools to help you pass with confidence. You can also check out our test bank platform, Exam ASAP. Our advanced adaptive testing platform featuring over 5,000 peer-reviewed questions designed to mirror the ENLEX experience. It includes detailed ration, daily content updates, and a 247 AI tutor, resources recognized as industry-leading and proven to enhance your performance. Not only that, our question bank platform has next generation enclelex question types with case studies. We are adaptive and AI powered platform that allows you to pass the ENCLEX the first try. With our question bank platform, you are able to see the analysis of how ready you are for the ENCLEX exam with a detailed analysis based on your performance. So check out our website for all those goodies. And I hope this lecture helped you feel a bit more confident with the pharmarmacology section, whether you're studying for nursing school or gearing up for the ENLEX. Again, I'm Mark Johnson, your enclelex instructor here at YNS, and I'll see you in the next lecture. [Music]