all right so today we're going to do um Farm one exam one putting it all together all right so this is your first exam so I just want you to know that it may not go the way you want it to because you've never taken an exam a nursing exam before nursing exams are hard you need to improve your test taking strategies okay your Kaplan your online resources your Pearson book your you know your med surge books for your um nursing courses all have practice questions in them do them okay even if you don't know what they're about use it to try to teach yourself how to critically think okay this whole point that's the whole point right we're trying to um help you learn it not memorize it and because you're not going to memorize it there's no way you can memorize uh all 500 pages 700 pages of that book it's not happening okay that's you're not going to we have to learn how to learn it okay and how to apply it so learn to manage your anxiety um which it sounds easier than it's easier said than done but it does help okay all right so your first exam we have role of the nurse principles of drug action medman ANS and your dosage calc go look at your blueprint if you want to see how it breaks down okay your exam is at 1:00 um Ada students no you're going to be in the Ada rooms non Ada there will be an announcement posted exactly where you're going to be if we're going to be separated and things like that okay um wear your appropriate attire your navy blue scrubs your clothes toe and heel shoes okay do not bring anything in there besides a pencil your ID and maybe your keys otherwise no no phones no watches no jewelry no nothing there are lockers outside if you need it but they don't have locks outside of 240 in building 2 so if you're in the library and you got to go to 240 first you better have enough time okay need to know your password to get into exam soft because we do not know it okay there's a c uh a calculator in examplify or exam soft okay don't bring your own you're going to be given a scratch paper you only get one hate it all right 90 minutes to take the exam and you have 15 minutes to review so you do have next gen questions you do have ink blackx style questions you have um select all that apply okay your next gen and your select all that apply have plus minus partial credit they are um your nextg that's something that you're not used to okay this is like a scenario and then you have questions based off the scenario if you don't know what those are go look them up okay your select I'll let them apply there is a plus minus partial credit it's very confusing but the computer does it thank God okay if you have any questions about it let us know all right so first we're going to do role of the role of the nurse in phaco therapy so I'm going to show you a little thing that I do to study okay it doesn't work all that great for this first test because there are these are like um these are not straightforward topics um as you get further you'll you'll understand what I'm I'm saying all right so role of the nurse we're going to go by the SLO so the SLO says no knowing the role of the nurse knowing your joint commission and knowing your drug approv of pro process okay so your drug approv of process let's go over that first drug approval process sorry Step One is preclinical investigation that is our lab we're in the lab okay we're on we're not testing this on humans we're testing this on animals on human cells but not actually humans this is when they're doing all the the data okay clinical is when we're doing it in on people we're giving it to patients whether it's Placebo whether it's blind double blind whatever it is that's when we're do we're we're giving it to humans and seeing how they react then we have our NDA which is our new drug application and that's when they review all of your pre-clinical and clinical findings and they decide if you're ready for stage four our last stage post marketing this is when we give it to the population and it's not FDA approved yet but it's pending approval right and so we're trying to see how it looks among the largest population okay so two and four is on humans one is on the lab three don't have anything to do with it but this is our first um attempt at humans okay so uh Joint Commission our safe our national safety guidelines okay there are lots of safety guidelines the ones that we care about are medications because this is pharmacology okay so we need to label all medications if we draw up our medicines in our syringe we need to label our syringe if we put it in a different container you need to label it if it's not labeled you cannot use it all right we give extra care of patients with blood thinners because patients with blood thinners we know our an increase if they fall they can bleed a lot so we definitely have to take care of that and then we do our Med wrecks our Med wrecks are at home meds when we do a med wreck we're trying to figure out what they take at home we're keeping it with their chart forever okay and we're giving it to them when they leave so they can take it home with them as well but we need to know the medication name we need to know the dose we need to know the route and we need to know the frequency that's all we need to know we don't need to care I don't care who prescribed it when you got it last who cares I need to know do you take it what do you take when do you take how much do you take all how do you take it okay all right so then rle of the nurse so we have our generic versus our trade okay okay we know our generics are what we use we do not use any trade names okay we use generic only we know that um generics are always smaller our lowercase trades are capitalized we have our scheduled drugs um we have scheduled Drugs That's table 2.1 in your book um I would definitely know that table okay we know uh level one is the highest risk of addiction and level five is the lowest risk of dependence or addiction um and that's why they have Controlled Substances or scheduled drugs is because we want to um be able to monitor patients and make sure that they aren't become we we know that there's a possibility of addiction and we want to be sure that we aren't um causing a problem okay we want to be able to monitor it not just the patient but the doctor too um so we know that tolerance and dependence happen right tolerance is when you have when you take the the drug over and over again and your body doesn't react the same way and then our dependence is that we have a a psychological or physiological need for the drug it's not the same thing as tolerance tolerance just happens sometimes people have a high tolerance from the get-go okay um but dependence is when we have an addiction okay and our level one we said was the highest risk of addiction that's like our heroin or level two is our narcotics like our morphine or fentanyl uh level three is our combo narcotics like our perco hydrocodone acetaminophen things like that uh level four is our benzos which are like Al praisal Lam lorazapam and some anti-anxiety medications and then level four uh and five is like our cough medicines with Codine okay because it's like this much coating and this much cough syrup so then we have our um critical judgment model ad piie assessment identification planning implementation evaluation on assessment that's when we're getting our Baseline data we're doing our Med wreck we're finding out their allergies and not just the like what they're allergic to but how they're allergic to we don't just stop saying what are you allergic to oh you're allergic to penicillin great we have to say what happens when you take penicillin right um we have to know what kind of herbal medicines they're on because we know herbal medicines over the- counter supplements can have interactions with medications we don't like them okay so when we go to identifications now we've gotten all of our data we're ready to identify problems so we're trying to see if why they're not taking their medications can they not afford it can they do we have a problem with what we've just do we have any interactions do we have any toxicities okay our planning um this is how we um prioritize okay how I see that okay okay my patient can afford this medication that's what I figured out in identification in my plan I'm going to figure out how to get them to afford it what what services do we have that's when we're doing all the planning to see how to implement it okay or in the identification I saw oh my patient do use a watch or oh my patient can't tell time or they have trouble remembering when to take their pills so in my planning stage I'm talking to them and I'm trying to figure out more about the problem so I can figure out how I can fix it okay I'm fixing it so how to fit their prescriptions if they're taking it four times a day I'm taking it with every meal and then before bed if they're taking it um once a day I'm taking it as soon as I wake up if I take it twice a day it's as soon as I wake up and right before I go to bed I'm using a pill organizer that's the planning we're thinking through um Solutions and trying to plan outcomes okay implementation is the action that's when we're doing it that's when we're administering the medications we're um doing it properly right when we talk about Med Administration right we're not leaving the medications at the bedside we're giving the medication to the patient watching them swallow it watching them take it and then we're documenting that it happened that is implementation okay when we get to evaluation we're saying did it work if I gave them blood pressure I need to recheck a blood pressure medicine if I gave them pain medicine did I recheck their pain right did it work did my education that I gave them implementation so the action so the education I gave did the education work how do I know the education did work the best way to know education worked is that repeat demonstration not just verbal or you know hearing it doing it watching them do it for themselves okay um and then we have our errors so we know errors happen right they failed to do a triple check they failed they leave their medication at the bedside they don't see if it's expired they did something bad okay um so our errors if it's expired we know we have we can't give those medications we have to go start we have to give it back to Pharmacy get a end date medication for um if our errors what if our patient refuses okay that's not an error per se but that is a problem that we might have in our adpie right um if they refuse it we need to figure out why they refused it right ask them say what makes you not want to take this and when they say something like oh I don't want to take this because it's a narcotic I don't want to become addicted you're talking to them about how that's unlikely to happen we're monitoring it you're not an addict just CU you took it one time if they say oh well my peill pill looks different we're double cheing we're triple cheing if they refuse it and they tell us why we need to do a triple check again okay um they always number three they always have the right to refuse okay just always have the right to refuse but we have to figure out why do another check make sure that we're giving the right person the right medication so we have to stop what we're doing talk to them do another triple check and then we can see if they have they can ref if we need to refuse it okay so when we have a medical actual medical error so I gave them this meter law that I thought was lenil whatever I gave him the wrong Meds first especially if like let's say I gave him triple the dose of morphine right I got to go check on my patient first is adpie assessment first okay is my patient alive and breathing then we can call the doctor and then we can report it to the to the board to the whoever needs to report it okay but we got to go through our list first and first is always add pie assess okay all right so a nurse is monitoring a pat patient for adverse effects of after administering a new medicine the patient says they feel dizzy and lightheaded which of the following actions should the nurse take should you tell the doctor tell them to remain in bed and check the blood pressure um document the patient symptoms in the medical record or administer an anti- edic so the key word here is first first okay usually that's bolded and like underlined okay first first means we got a problem that I can fix before I leave okay am I going to fix their um dizziness maybe not but I know when people are dizzy or lightheaded they're going to pass out so I want them to stay in bed and I'm going to check their blood pressure okay that's first then I can tell the doctor document it this anti- tic has nothing to do with it okay so those we have to pay attention to those keywords all right so now we have principles of drug action lovely all right so we have our phoc kinetics our pharmacokinetics is absorption distribution metabolism and excretion okay when we go over those absorption that is how it gets from outside my body to inside my body and we're trying to absorb it whether it's through the stomach whether it's through your muscle your IV whatever how do I get it into my bloodstream okay so things that can affect that formulation we know that um IV is the fastest absorption because it's going directly into my bloodstream I don't even have to absorb it it's right there right then we have I I is the ne intramuscular as our next fastest subq then our po then our transdermal that's um that's what we mean by dose formulation and Route okay we also know that our liquid doses of our po meds work way faster than our our pills right so we have like different nuances even within each one okay we know our route we just talked about that the surface area if it's subq and it's going to go through a lot of fat it's going to increase my absorption time GI motility if I aren't if my stomach isn't moving right if I'm constipated and I'm not absorbing Med medications I'm going to increase my time blood flow to the organs wherever you're getting the medication lipids um so if it's fatty if you have food in your stomach we know that food um can increase food can decrease the absorption rate that's why a lot of medications you have to take on an empty stomach okay so food decreases absorption then we have our drug interactions and our herbal interactions we know that there are are over the- counter stuff like our an acids our an acids are a big one that can decrease the absorption because we're neutralizing that stomach acid and if we don't have stomach acid and we can't break down the pill it's not going to get absorbed okay our distribution is now it's in the blood and now I'm getting it to where it's got to go okay things that can affect that that is your um if it's high protein if it's got a lot of bunch of protein molecules it is has decreased AB distribution because it can't fit through all of those little capillaries and membranes and things if we have a low blood flow like we have hypotension we have um decreased cardiac output we don't have any blood right my blood flow my distribution will be decreased and then our drug to drug interactions this is when that happens okay so sometimes we have addition and synergism so we like those but then we have our antagonists so now we've gotten to the where we're trying to get to where we go want to go and the antagonists are blocking us from getting there and using it right or are placement ones are pushing us out and sitting there instead so we can't be used okay um we know that drugs that get displaced or if we have like extra free drug just hanging out we don't like that because we are at risk for what toxicity we're going to say that 17 times we also know that drugs that compete for the same receptors so if you give me morphine and Fentanyl and they're both competing for those moo and Kappa and Delta receptors I can have an overdose or a um toxicity right because drugs that have um compete free drugs and drugs that compete for the same receptors increase the risk of toxicity all right liver I'm sorry metabolism metabolism where does it happen in the liver if we have any problems with our liver if we have liver dysfunction if we have um you know hepatitis therosis um liver failure liver dysfunction liver information whatever it is if you have a liver problem you have a metabolism problem and you cannot metabolize these drugs so we need we are at risk for what toxicity okay when we monitor our liver function we're monitoring our as or lft is our a Al a lft okay we have um I'm sorry we have enzyme Inhibitors and enzyme IND uction medications and those medications are the ones that speed up your metabolism or slow down your metabolism of your liver and that can affect how drugs interact okay um our first pass effect so first pass effect means that half of the medication is metabolized before you get to use it this can happen certain drugs have a higher risk of um the first pass effect we have to work to overcome that we can change the route we can give it IV we can give it bual um or we can increase the dose and so if we increase the dose we have more available and so then if it half of it gets metabolized I still have the other half to be able to be used okay but it's half as metabolized before you can use it um we're going to talk about that in a second all right now we have excretion excretion happens where in the kidneys but what can the kidneys filter so the kidneys can filter water soluble medications electrolytes it can filter small molecules and free drugs that's it that's all I can get out if it's anything else doesn't happen if it's fat ain't happening carbs ain't happening we're talking water soluble electrolytes small molecules and free drugs it's not even doing a bunch of protein either okay we can also excrete it through our lungs sweat and bile but that's you you know not as often so we've talked about two organs we've talked about your liver we've talked about your kidneys if we have any liver problems we're going to be at risk for toxicity if we're having kidney problems so that's chronic kidney failure that's acute kidney injury whatever okay I can't excrete it I'm at risk for what toxicity so our people with liver and kidney dysfunction are at increased risk for toxicity so they might need lower doses okay that means when we have Labs that we need a monitor before we give medications so for we talked about the ones for the liver for the kidney we're looking at The Bu we're looking at the cening and we're looking at the GFR those will tell me if my kidneys are working all right so our um definitions right we have our onset which is how fast it how long it takes to work our duration how long it takes to work how fast it's going to work um duration is how long it's going to last all right our half line life is how long it takes to excrete we know that halflife means that um half of the dose has been excreted from the body um and so we know that the long half lifes means that it has that narrow therapeutic index because if it takes a very long time to excrete it from my body that I have a risk for toxicity okay so we have our narrow versus our wide therapeutic indexes our medications that have those long half-lies have that narrow therapeutic index and they are increased risk of toxicity when we have a wide therapeutic index we have a big cushion and we're at a very it's a very safe drug okay and that they usually have short half-lies okay so we have our Peak and our troughs so we went over what times you can measure Peaks um and what time to measure trough in the lecture go remember those okay our Peak is the highest level of um the medication in our blood and the trough is the lowest level in our blood okay um so we need to know when to to assess those we know Peak is at the highest level so it depends on the route of what time we um check your peak level but your trough is the lowest level so we usually do that 30 minutes to an hour before the next dose is due so we don't overdose you and cause you to be toxic okay we know a loading dose is that um we try to give you a bunch of the medication to get you to that therapeutic level faster and a maintenance dose is going to maintain the dose after the fact okay so that's that Q daily every hour whatever it is okay um agonists we know mimic and antagonists block straightforward then we have our elderly elderly are at increased risk of toxicity because nothing works okay so like we have decreased liver we have decreased kidney we have decreased absorption we are at increased risk of toxicity because of these two because we're not getting it out we're not metabolizing it we are at decreased risk of absorption so they may not work as well right we have more body fit f fat oh Jesus more body fat we have less blood flow less cardiac output and so we know that these means that it's not going to get to where it's going then I can't metabolize it and then I can excrete it so I'm toxic so our patients that have the liver and the kidney issues what did we say they may need lower doses okay we can't decide that but we can help um be aware of it and make sure we don't overdose our our P our older patients okay we got to monitor those labs that we talked about and then we have our side effects and our adverse effects the keyword is um I'm sorry side effectss versus Adverse Events our Adverse Events are when something really really bad happens I have anotic shock I'm allergic to it a side effect is a known reaction or an adverse effect is a known reaction effect an event effect an event that's what's the difference um knowing that a side effect is a known thing that's going to happen that's okay they can still be deadly and when then it turns into an adverse event but side effects or something we know is going to happen and we're expecting it and we're watching for it adverse event is unexpected all right let's do a practice question so complete the sentences by choosing the most probable option so a patient receiving multiple medications the nurse is reviewing the principle of phaco kinetics match each process with the correct desri description so the process from which uh a drug is chemically altered Primary in the liver to be excreted so to more easily eliminated whatever it's that is metabolism so that's C the movement of drugs from a site of administration into the bloodstream a absorption the transportation of the drug throughout the body to its Target's tissue that's distribution and then the removal of the drugs from um primarily through the kidneys that is excretion so c a b d this is like an inle style question this is a very easy one they're not going to be that easy I hate to tell you all right so now we have medadmin so first let's talk about medadmin and then we'll get into a question and we'll talk about dosage calc okay so medad men we know the six rights that's the right patient medication dose frequency route and documentation when um we make sure we have the right patient we're asking them for those two patient identifiers right we're not saying their name because they will just say Yes um when we document we're checking um what's needed do I need any extra data besides that I just gave this medicine do I need a blood pressure a Pain Scale whatever else the seven parts of the order patient Med dose frequency route but now instead of documentation we need Med the doctor that um name/ signature and the time and written okay um then we have our triple Treck pull prep pass when I pull it out of the mar when I prepare the medication and when I put the pet medication in the patient's hand when we're checking those at those three times we're checking for the six rights okay um we have three not three yeah three sorry three different routes right we have interal topical parental our interal is our P NG Peg um bu nucal OD sublingual all going through the mouth or through into the stomach okay um so when we have our po we have to worry about okay is we know that the liquid is faster than a pill and a pill is faster than T coated um but more importantly than that can they swallow are we checking to see if they can swallow beforehand um if they cannot swallow um let me rephrase that if they have trouble swallowing we can crush them that's perfectly allowed if they cannot swallow like at all we're not going to force it we're going to do one of these other routes we're going to find another route we're going to talk to a doctor otherwise it's okay okay um so NG and pegs we have to crush to put them in can I crush this pill what can I Crush basically anything what can you not Crush andic coded delayed released sustained release um delayed release sustained released extended release right ex Dr e r Sr whatever it say EC behind it that's what we can't crush and we know our bual ODT and sublingual they work really really fast because it's in the it's in this mucous membrane do not drink after okay we have um a do not use list know your do not use list know your rations that we went over okay um yeah so topicals this is our dermac ter our our lotion ointments creams our drops our inhalers our transdermal patches our vaginal and rectal for all of these except for an inhaler wear gloves don't touch them if you touch any of these you're going to absorb them we don't want that okay we're gloves um for der for our ointments they are not systemic the skin do not put it on Open skin and less directed um and all of these things wherever you're putting it needs to be clean and dry first drop same thing clean and dry first hold that lacrimal duct know the ear angle for adults know for nasal that we don't blow our nose we blow our nose before we don't blow our nose after know how to use um you an inhaler just know what it is we'll go over that in oxygenation our transdermal patches once again clean and dry wear gloves no hair don't cover it okay take off the last one before you put the new one on vaginal and rectal make sure you have the right position make sure you clean and dry the area first and make sure you use Lube all right um parental so this is intradermal which is in your forearm subq which is the arms the stomach the um your love handles under your scapula and then um the tops of the thigh it is slower than our IM it's the slowest parental because it's got to get through all the fat tissue our I is our deltoid our ventrogluteal and our vastest lateralis okay the ventr Glu is a preferred site we love it it's not near any blood vessels it's um a large muscle that's like the go-to one for adults um one thing we did not talk about on here is allergies right so before I give I know we're doing the six rights but when we're checking the right patient and we're checking the right medication we're also checking hey do they have allergies what allergies do you have what happens okay we already talked about that a little bit um when we do our pull prep past too make sure when you're preparing it we have a quiet environment okay we don't want all those distractions all right dose let's do this and then we'll get to doses Cal so um a nurse is administering medications to a patient what aspect is not a part of the six rights right medication documentation doctor or time so this is a six rights so is the right doctor um right time is the right frequency right documentation is correct right medication is correct the wrong one is Doctor all right so let's talk about dosage count before we do a practice question okay um dosage calc please remember your rounding rules please remember when you're supposed to use a a leading zero when you're supposed to use a trailing zero uh I mean we don't ever use leading zeros we only ever use I'm sorry we always use leading zeros never use a trailing zero know how to do your round all those fun stuff okay all right so a patient who has seolin 100 milligram per kilogram IV every 4 hours they weigh 20 2 20 220 PBS The Available um says to reconstitute the sephos zolan powder in 25 Millers of water um for a concentration of 5 grams per 5 MLS how many meals should the nurse administer so the first thing I want to do is let's only let's see what numbers I need let's go all right so I do always do um dimensional analysis first sorry so what is my question asking for milliliters so I put it over here do I have any milliliters yes I do I have five milliliters and it's attached to this five grams they're attached they can never be separated so whatever I do to the bottom I've got to do the top do I have any grams no but I do have milligrams so I got to throw in a conversion so I'm going to throw in my 1 gr is 1,000 milligram okay now those get to cross out do I have any milligrams I do I have 100 milligrams per kilogram so I can throw that in there do I have any kilograms now those cross out do I have any kilograms no I do not but I do have some pounds and I know there's a conversion so I throw my conversion in now my kilogram can cross out 2.2 lb I can add my 220 lb and I'm done okay so I used all of I used 100 milligrams per kilogram I used my 220 I used my 5 grams per 5 Ms okay I did not use this 25 milliliters why did I not use that that's a number up there I should use it right no okay don't use it because I don't care how much I don't care if you had to add 151 drops of whatever to equal a concentration the whole point is the concentration is 5 grams per 5 MLS if I had to put 5 Ms or 500 Ms it wouldn't change the fact that the concentration is the concentration I don't need this number it's an extra number all right so I multiply across 5 * 100 * 220 is 110,000 5 * 1,00 * 2 1 * 2.2 * 1 is 11,000 okay divide 10 nl's all right so if I'm doing dimensional um desired over half first I have to convert everything to the same I've got to get rid of this kilograms I've got to get rid of these pounds and I got to change one of these around all right so first I'm going to do my um pounds so pounds to kilograms um kilogram is bigger than a pound so if I'm going from small to large I divide so 220 ID 2.2 equals 100 kilogram all right so now I have to convert my milligrams in grams so I'm going to go I'm sorry I'm not not yet first I got to get rid of I got to figure out what my actual order is okay so I've got to get rid of these kilograms right here you can do this in the beginning or at the end but do not forget to do this part so for every kilogram I get 100 milligrams so that just means multiply 100 * 100 is a 10,000 okay so now my new order is seolin 10,000 milligrams IV so if I want to go from milligram to gram I'm going from smaller to larger so once again again I divide 10,000 / 1,000 is 10 so now my new order is SE is 10 gram spoolin I have available five grams per 5 MLS so my desired is 10 gram I have five gram and I multiply by my volume 5 milliliters 10 ID by 5 is 2 * 5 is 10 so if you're doing desire to or have you have to remember to do all this pre-work before you can plug it into your formula okay if you miss a step it's over and like I said you can do this at the beginning or the end but you cannot forget it all right if you need help please ask all right St have ANS autonomic nervous system all right so this is how I study once again if this doesn't work for you don't use it this is how it works for me so SNS versus pns SNS is fight and FL fight or flight pns is rest and digest when I have an SNS triggered I have my diasis I have hypo salivation so I'm dry I might have dry mouth I might have dry eyes I have tacac cardia I have hypertension I relax my bronchi which means I can breathe better I have constipation decreased GI motility I have um high blood sugar I release epinephrine and norepinephrine and my bladder relaxes which means that when it's relaxed you actually have decreased urine output if I know all this then I know all this okay okay let's go over to pns and then we'll talk about the drugs when our rest and digest we're going to have meiosis so people constriction okay we might have um incre drooling increase elevation increase lubrication of the eyes sweating that kind of stuff we do not sweat over here okay we sweat over here H braic cardia hypotension because we're resting we can have bronch ey constriction don't like that okay that's like wheezing that's like a short of breath okay we can have diarrhea because now my GI is really going a bladder constricts on your bladder constricts that says hey you got a pee so you can have increased urine output okay all right so let's go back anticholinergics and are adrenergic agonists those are what do fight ORF flight anti-cholinergic looks like all this okay the biggest thing is we have this um dry mouth dry eyes right with anticholinergics we have all of these symptoms right we have constipation we have um Bronco relaxation Tac cardia hypertension drooling I'm sorry um dry mouth dry eyes if you have dry dry eyes you cannot have glycom and take an anti coleric okay because it will increase the intraocular pressure that is a direct contraindication we know that if we're um having this dry mouth or dry uh eyes with our eyes we can use the lubrication like the um the eye lubrication for dry mouth we use um we can chew gum we can make sure we brush our teeth we can um use sugar-free candy okay aeric Agonist so alpha 1 guess what we have hypertension Vaso constriction okay we have we also have H tachicardia um beta 1 one heart so high heart rate high blood pressure beta 2 two lungs so we have that Bronco relaxation and then beta 3 causes um bladder relaxation which is increase of control so we use it for like overactive bladder um an anticholinergic example is atropine we're going to talk about that on a lot that is an the anticolon Eric all right so now we have our coleric agonists okay our colonics so we have direct and indirect are direct work directly on a colon acline indirect worked on the aceto colon esterase direct guess what same problems okay we have um we have to monitor our IO because we have this increased urine output we have to monitor for blurred vision because we have myo is we have hypotension so we're at risk for Falls okay we have to monitor for our orthotic blood pressure we also have hyp um bra cardia and diarrhea okay we got a monitor for all those for our indirect we can have muscle weakness um that ptosis which is like eyelid droop and the diplopia is double vision okay then we have our aeric intactness so our alpha 1 adrenergic antagonist or Alpha 2 adrenergic antagonist beta 2 or our beta blockers okay not all beta blockers let's talk about alpha 1 so alpha 1 once again they cause vasodilation so you're going to have picardia you're going to have hypotension you can also have impotence and ejaculation problems because of the smooth letter smooth the bladder neck becomes relaxed and because I can't it gets relaxed you can't ejaculate properly because I have hypotension and that phaso dilation I can't get the blood into the penis and so that's why you have impotence okay um the alpha one for urinary flow so we have an alpha one just for urinary flow that one we can have reflex tacac cardia that is the only paradoxical reaction okay which means opposite not intended alpha 1 for urinary flow can cause reflex tacac cardia um our um beta blockers right our beta 1es or beta 2os beta ones on the heart beta 2os on the lungs our beta ones um are not always selective though so we have to monitor for braad 2 like the like I just says not selective okay so our beta 1es we got to tell our patients that they're going to become hypotensive they can be braic cardia we've teach them how to take their blood pressure how to take their heart rate what the cut off is when you don't give it to them okay if they're already hypotensive don't give it to them if they're already bardic don't give it to them and you have to tell your patient that too um we of to have to monitor since we have all of these hypot tensions over here that falls that safety we're changing positions slowly we're doing um we're preventing that dizziness okay Alpha 2 agonists are actually on this side it's the only one I know it's confusing I'm sorry but it causes bradicardia hypotension just know that all right this is the best way I can simplify it you just got to know it okay you've got to know which ones are SNS which ones are pns know it just know it cool all right so let's do a um a test question all right a nurse is administering an anti-cholinergic so what is anti-cholinergic fight or flight okay what side effects should the nurse monitor for sweating seizures nausea tachicardia hypertension constipation diarrhea myiasis meiosis dry mouth so let's go over these one by one so when you see a selector that apply think true false is it true you sweat no with anticholinergics you do not sweat it dries you up you have dry mouth dry eyes it dries you up I know fight ORF flight you sweat don't think you're thinking too much just know that it dry dry no sweating does it cause seizures did we talk anything about seizures no nausea no Tac cardia yes I need my heart rate to be elevated so I can profuse my brain to get me out of this bare situation okay high blood pressure once again yes happens right constipation because I'm not worried about go to the bathroom when I have to fight this bear so constipation is a side effect okay diarrhea we just said we slow motility no so diarrhea is not happening myasis or meiosis remember those are opposite myasis is dilation meiosis is is a constriction I need my eye people's large so I can see the bear and where the sticks are when I run away from the bear and I don't trip so myasis yes and then dry mouth that's another that's one we talked about dry mouth dry eyes big ones so because we're not wear about drooling while I'm running away so our side effects are d teoc cardia e high blood pressure F constipation H myiasis and j dry mouth if you do not know these learn them okay you've got to know them good luck you know more than you think you do re-watch um reist to your recordings if you if you record lectures re-watch this video do whatever you need to but study and study appropriately we're not studying to memorize we're studying to learn you are more prepared than you think and you're smarter than you think you've got this you're all going to do amazing good luck