Event 8: Pharmacology Crash Course with Prof. Lawes – Part One (2022)

00:01 Hi everyone. I know you're all coming in.

00:04 Welcome to today's pharmacology crash course.

00:07 My name is Prof. Lawes, and I'm going to be the one that's with you for today. Part one and part two.

00:13 I love pharmacology and I know that is super nerdy.

00:17 Yeah, super nerdy, but I've taught it for almost 20 years now, so this is something I'm really used to.

00:23 I've done NCLEX reviews, so I'm going to give you my very best.

00:27 Well, let's start if you don't mind, in the chat.

00:29 Like, I love that you're all saying hello.

00:31 Could you tell us where you're from? Like, what city are you or state or nation are you coming from? That kind of thing? Oh, Canada.

00:39 Cool. New York city. New Zealand, Philippines.

00:43 Look at you guys. That is so cool.

00:45 Anchorage. Very cool. Mexico.

00:47 Singapore. Wow. Okay, so this is so cool, is it not? So sometimes when you're a nursing student, you feel like you're all alone, like nobody else understands how hard it is to be a nursing student.

01:01 And look at this. All of your friends around the world understand how hard it is.

01:08 Okay, if you didn't recognize this yet, I have a very short attention span, so I'm going to teach like you have a short attention span because we want to keep things moving. And I have put my very best thought into what are the most important things you need to know as a nurse to be safe.

01:25 And if you're going to take an exam for your license, that will also play into it.

01:30 So this is part one of two.

01:32 At the end of this, we will tell you how, where to go and how to sign up for part two.

01:37 But stick with us and we're going to kind of get things rolling.

01:40 So hey, that's me. I think we've already got that covered.

01:44 We have a poll that's going to be coming up. I just want to know what you guys know about Lecturio. Okay. That's who I, um, teach with right now, in addition to teaching in a nursing program right here in my town.

01:56 So you've got that. How familiar are you with Lecturio? Good job. Now you're learning how to use the poll.

02:05 It's not really hard. You just click on what you want.

02:10 Oh my goodness. Look at your response rate.

02:13 Oh, you guys are crushing it.

02:15 This is fantastic. Thank you for you giving us all that information.

02:19 Appreciate it. Now um, this question is worded a little funny.

02:24 I don't know what I was doing when I wrote this one, but I'd love to know what type of program are you in. So are you in an ADN program? Are you in an MSN program, a BSN program, an LPN program? We just wanted to think.

02:36 Or maybe there's another one that we didn't get.

02:39 So we love all nursing students here and nurses, if you'll just let us know, because we want to make sure that we do programing that that rings a bell for you.

02:48 Something that you really want to do.

02:50 Hey, Ue5 in master school.

02:52 Go go go. We need you out here.

02:55 And here. And congratulations on making it all the way through nursing school.

02:59 Hey, Lpns 12 of you. Rock on.

03:03 That is so cool. Oh, look, more of you.

03:05 13. Hey! The others, if you wouldn't mind just putting in the chat.

03:09 The one that you type in.

03:10 Let us know what you're studying, what type of degree. Because we want to make sure that we get we have resources for you also.

03:17 Now, as we're answering these polls, I want to make sure you have something to write with or take notes on because we're going to do a practice quiz.

03:25 Don't get alarmed. We're going to do a practice quiz.

03:27 And then all throughout the presentation, part one and part two, we're going to walk through those questions.

03:34 Okay. So have you come to any other events with us? That's the next poll. Have you come to anything else? Lecturio. Um, have we met you yet or are you brand new? So we're going to switch to that poll that asks if you've ever attended any events with us. So you'll see it pop up on the right when they're ready.

03:53 And we're getting ready for the pretest.

03:56 So on my screen, the poll hasn't changed, but that's okay.

04:01 Um, we would, uh, Kate or Alicia are here with us, and they're going to fix that. If they can get that poll up, they will. If not, otherwise, we're just going to keep rolling along.

04:12 So if you have a piece of paper, right, could you write in the chat that you've got something that you can somehow.

04:22 Oh, it was just a chat question haha.

04:24 All right Kate got it.

04:26 So see who's confused.

04:27 It's not you guys. It would be me.

04:30 Alright. Hey, so if you're a first timer, go ahead, just write first timer in there.

04:34 That helps us. Good, good.

04:38 Super helpful. Okay, now this is going to be I hate to use the word pretest for you, but the reason this is helpful is because it's going to give you an idea of how much you learned, you know, in nursing school.

04:52 I don't think I've gone to any type of school that made me feel less smart and pretty sometimes than how I felt in nursing school when I was just learning all this stuff.

05:02 So we want you to know you know more than you think.

05:05 Do your very best on answering these questions, and then we will walk through them. And I'm going to use my experience as an NCLEX instructor. I've taught NCLEX reviews, the kind that, you know, drag on for days for you.

05:16 I'm going to use my best strategies with you on how to rip apart a question.

05:22 So we've got this moving.

05:25 Let's go on to our next one.

05:27 Hang on. Let me just move this over here.

05:30 So we're getting ready for the pretest if you will, just number one through ten.

05:34 That's how many questions we have.

05:36 We're going to give you a minute for each question.

05:39 Now it'll be quiet while we're doing that and we'll just advance them after each 60s.

05:45 Okay. So here is the first one.

05:48 Oh it's not sorry. You got ten minutes to take him.

05:52 It'll come up as a poll.

05:53 You can see the full answer choice on the slide.

05:56 So it might be a little cropped in the poll.

05:58 You have 60s per question.

06:00 We have ten questions okay.

06:02 So I'll be off screen while you do that.

06:05 Are you ready? Okay, I'll be quiet and good luck.

06:09 Just do your best and try to have fun as much as you can.

16:41 Okay, so hopefully you've got ten answers there.

16:44 If you don't, no worries.

16:47 So here's what I want you to get your mind kind of wrapped around for the rest of the session. So it would be great if you have somewhere to take notes, whether you like to do that digitally on a tablet or an iPad or on a computer or on paper, it just matters that you keep your head in the game and thinking about the things that we're saying.

17:06 So if you see this session right here, you'll see this little stopwatch right there that will see a 62nd interview or overview.

17:15 That means that I have taken a look at the most important things that I think you need to know as a nurse, and that likely could come up on the NCLEX.

17:26 Now, if anyone tells you, oh, this is going to be on the NCLEX.

17:29 That's not true. Nobody knows.

17:32 You could go in with four of your friends, right? And all four of you are going to have a different test because it's all computer adaptive tests. So sometimes faculty say that just because they want you to pay attention, but just know that nobody knows for sure exactly what content will be on the test.

17:50 We know categories of content.

17:52 We know topics, but we don't know exactly which ones are going to be on the test.

17:57 So as we're going through this, you'll see the 62nd overview.

18:01 That's really important information that you'll want to watch for because it's going to be a quick summary crash course kind of information.

18:09 So this is a little bit about who we are.

18:11 We are Lecturio um the full course I saw that we have several premium members here today.

18:17 That is the bomb. Thank you for coming today.

18:20 We want to keep offering things for you and for all our nursing student friends.

18:24 But you guys know if you're already a member, you've got 400 videos, all short videos ready for you to go on.

18:30 Pharmacology. We've got a thousand questions and video questions we have we have 400 Cuban questions okay. So what we want you to know is that we're a resource that's here for you.

18:42 So we have a lot of videos.

18:43 And then after each one of those pharmacology videos, we have a thousand plus practice questions to help you review.

18:50 And we'll make Flipkart's for you. We call them spaced repetition at the bottom. And we've got 400 more hard practice questions to get you ready for your final exam or for the NCLEX. That's all on our site.

19:04 So we'll talk to you a little bit more about that at the end. But let's start looking at side effects. This is the thing that is so overwhelming right? This is what kills you when you get to your pharm course.

19:16 Now, how many of you are in a farm course right now? So just tell me in the chat.

19:21 Are you in a pharmacology course right now? So that would just be a yes or me.

19:25 That's what we're looking for. Okay, cool.

19:28 Hey, Kathy. We love that too.

19:29 Thanks. Okay, cool. How many of you are here? Oh, you have a quiz in 90 minutes.

19:37 Oh, I just wish I could give you a hug.

19:39 Even if you're not a hugger, I would want to give you a hug.

19:43 Nicolette, your program doesn't have one, okay? I mean, we got you. Some schools don't, but that's okay.

19:49 Now, hey, if you're here for NCLEX, will you just write in NCLEX? Just write NCLEX if that's what you're looking for.

19:57 And that's why you're here? Because I want to make sure I kind of ride this the way it is.

20:00 Okay. Yeah. That's the wow.

20:02 Those five letters strike fear into the hearts of all of us, don't they? All right.

20:07 We're going to help you wrap that around.

20:09 Oh, you do med cards every single week.

20:12 Wow. Okay. All right, now, if you're here for NCLEX and and remember that is not going to start until 2023.

20:21 And there'll be a lot of you that take the NCLEX before then.

20:24 But we're going to do a next gen pharm one two.

20:28 So we've got that ready to go for you.

20:30 Okay. So when you look at your pharm textbook they're usually ginormous.

20:34 There's a million side effects.

20:35 Like it's almost as overwhelming or maybe even more overwhelming than a med surg textbook. So I want to give you some ideas of how to kind of work that in.

20:45 Now, if you have a challenging time with studying, um, it's difficult for you to focus and to pay attention.

20:52 You are my people. So here's what I'm going to do with you.

20:56 As we're going through this, we're going to use a technique where you and I agree for the next 25 minutes, zero distractions.

21:04 Do whatever you can, move your phone away from you, turn your notifications off.

21:08 But I want you to just give me 25 minutes of straight up focus time.

21:13 Okay? Then we're going to take a five minute break, and then we'll come back and do another 25 minutes, and then we'll finish the class out.

21:20 So I want you to kind of get that feel for what does it mean to spend 25 straight minutes studying together? So you and I are just going to be study buddies today. That's what we're going to do.

21:30 It's like you and I kicking back.

21:31 I've got my Diet Mountain Dew right here, and we're going to have a study group.

21:36 So where do you begin with all the side effects. Should you memorize all of them? No. First of all, it's impossible.

21:42 And no, all of us in practice, we look things up.

21:45 You will look things up.

21:47 But I'm going to tell you the types of things you want to know.

21:49 To be confident heading into your practice or going in to take an exam.

21:54 Now what if you're one of our friends that you don't take the NCLEX? If you wouldn't mind, would you write what type of exam for your licensure or what title you're registering for? So if you'll drop that into the chat.

22:07 If you just pop that in the chat, let us know what you're studying for. And we'll keep that in mind because we want to recognize we know if you're calling, if you're joining us from Canada or the US, you'll be taking the NCLEX.

22:18 Clicks o, f and p. Awesome family nurse practitioner.

22:22 There you go. Rpm. Excellent.

22:24 Okay. Super cool. That's fantastic.

22:28 Hey, we love having you in FNP students.

22:30 We've got even more advanced pharm for you too.

22:32 But this is going to be a great review for you.

22:36 Excellent. Thank you for all that.

22:38 Yeah, it's new for Ontario and British Columbia.

22:41 Look at that. You're you're teaching us. Oh, Hershey.

22:44 What? Um, in the US, we take the NCLEX to get an RN license where you are.

22:52 What's the name of the test you'll be taking? And what's the name of your license? That's all we're looking for. Because I know our friends in the UK, you're like nurses and midwives. It's a little bit different than how we do it and it's so fascinating to learn. So first tip let's get rolling.

23:07 The first thing I want you to think about, and these are the top two tips when you start looking at side effects.

23:12 Stop. Here's what I want you to do.

23:15 First of all start a family.

23:17 So look at the drugs, not as individual drugs.

23:20 I want you to look at them as a family.

23:22 Right. So Ace inhibitors, look at what the side effects are for Ace inhibitors as a group.

23:28 Beta blockers. What are the side effects for beta blockers as a group.

23:32 Antipsychotics. That's a psych medication.

23:34 What are the side effects for antipsychotics as a group.

23:39 So think of them not as individual drugs but as groups.

23:43 If there's something really weird about one individual drug in the group, and it's important, we'll bring it to you here in this review.

23:50 But stop trying to remember individual drugs.

23:53 You want to remember your information about drugs by family or the category, and then you go back and learn the names as you're going on.

24:02 Okay. Yeah, I know that gets so just Leon saying that her book divides them by therapeutic use, which for beta blockers, you know, all the different things you can use beta blockers for, um, anxiety. And I use it.

24:14 I it. I recommend it for test anxiety, um, for blood pressure, for workload, for all kinds of things.

24:20 So it's really complex to do it that way.

24:22 But for you, I want you to start thinking of them by family.

24:25 So that's tip number one.

24:27 So tell me in the chat, what am I recommending that you group all drugs together? As what? When you're studying side effects. Group drugs together as what? Who's the first one that can get the word? Yes.

24:39 You're with me. Yeah, yeah, yeah, you got it.

24:42 So make yourself a note.

24:44 Your follow up things. That's what you're going to start doing. Pull back and try.

24:48 And instead of trying to look at a gajillion drugs do that.

24:51 Now second tip like you're going to get your money's worth, especially since this was free just by taking this one home with you.

24:58 But you have to know drugs that can take out an organ.

25:02 Okay? You need to know the side effects that are severe or organ damaging, right? If this is going to risk someone's life or risk the use of an organ, that's one to know. No.

25:12 Okay. So that's what you want to know.

25:15 So first learn everybody as a family.

25:17 And then ding ding ding ding ding.

25:19 Anything that has a really nasty side effect that can cause significant harm, not like itching or something like that, but significant harm.

25:28 Right? That's what we want you to keep track of.

25:30 So here's the good news.

25:32 You came today. I made the list for you.

25:35 So you've got that right at your fingertips.

25:37 I'm not asking you to go back and to make it, but I am going to give you a little bit of homework on that one. So let me show you an example of what I'm talking about.

25:44 Things that are bad for ears.

25:46 Now wait a minute. Didn't I just tell you to look at drugs as a family? I did, as far as the regular old side effects, but these are no brainers.

25:54 Well, you have to use your brain.

25:56 But this is what we want you to do.

25:57 Think about which groups of drugs, which families of drugs can cause ototoxicity. Toxicity means whoa, bad.

26:07 It's toxic. Right? Whatever comes in front of that word.

26:11 Toxic means what it damages.

26:14 Odo is for ear. So oto toxicity means this will knock out my hearing.

26:20 Damage my hearing. Now look up here.

26:22 We've got our icon for our 62nd overview.

26:26 These are the types of tips that you really want to make sure like compress down for you.

26:30 So you'll need to review them regularly and it'll be stuck in your mind forever.

26:35 Okay so antibiotics is one that are ototoxic.

26:38 Now I listed some names there for you.

26:41 Myosin tobramycin macrolides.

26:44 They can be reversible. What happens with macrolides.

26:47 Loop diuretics that's otherwise known as furosemide.

26:51 Remember on the NCLEX exam.

26:53 And I would I would imagine on a lot of your exams that the generic names are used for the drugs. So furosemide is known by a trademark name of Lasix.

27:04 But what you'll see on your exam for NCLEX it will be furosemide.

27:09 So it's all that big. Long tongue, twisty name is what it is.

27:12 So we're talking about Ototoxicity.

27:14 There are three groups of drugs.

27:17 Antibiotics, loop diuretics, and a certain chemotherapy drug.

27:23 Now, anyone recognize that drug? Do you remember it from the test questions? Okay, if you didn't know this about cisplatin, that was not meant to be a trick question because I'm going to teach you.

27:34 What do you do when you see a question on an shouldn't happen on your on your course exams, but if it happens on the NCLEX.

27:41 Oh my lanta, what do you do? Okay, so before we move off this slide, if I was studying with you, we'd have to say like, okay, let's stop and think about this for a minute. How can I put this into my brain thinking about ears so I may touch my ear and think, antibiotics, diuretics, chemotherapy.

27:59 Okay, so make sure you start laying that layer in your brain to remember.

28:04 This means I can watch for it on test questions.

28:06 I can recognize it in patient statements because that's a real that's a testing concept when they're writing exam questions. They may say the patient says these four statements. Which one requires follow up by the nurse.

28:21 Well, if a patient is on any one of these categories of medications or specific medications and they say I, I keep having to turn the TV up.

28:30 See, that's how the angry elves that write those questions, that's what they'll do.

28:35 They're saying, do you recognize that with a loop diuretic? Loss of hearing is a risk factor.

28:41 And do you recognize how a patient might say that to you? So they won't just say the patient is experiencing ototoxicity.

28:50 They'll try and flip it around like, hey, patients said she can't get their TV up loud enough, or you speak to the patient and they don't seem to understand you.

29:00 That's the kind of mindset I want you to be getting into.

29:03 Now we've just covered one organ.

29:07 Right. We've just covered ears because you're getting ramped up, and I want you to feel comfortable with the format.

29:13 So you're looking for that 62nd overview.

29:16 You already know two of the biggest tips we gave you on the slide previous.

29:21 Can you think what were the two tips I'm going to see what you can recall.

29:26 So the slide just before this we talked about two important things that you can do as you're preparing for NCLEX questions or for course exam questions.

29:36 Now pause and try to remember.

29:39 Yeah. Don't just stare.

29:40 You want to make sure if you can remember. There you go.

29:50 Look at you okay. So if you didn't remember it's okay.

29:54 But what you just did is what's going to help you study.

29:57 You take in a little bit of information, then you stop and ask yourself a question without looking at your notes.

30:03 Okay, well, why can't you look at your notes? They're yours. Well, what I went and studied on was EDSAC.

30:09 So a lot of my colleagues do a PhD in it, and I just didn't have the attention span for it. I wanted to understand, how do you learn what I mean? I want to learn how my brain works.

30:19 I want to learn how other people's brains work.

30:22 So this is a strategy that we cause.

30:25 We call pause and recall.

30:26 You stop for a minute, and either you ask yourself a question or your study partner asks you a question.

30:31 But just reading information and trying to remember it and going on will never get it where you want to get it.

30:36 So good. Those of you got it.

30:38 Excellent. If you didn't still excellent because you're doing the work it takes to make the information your own.

30:44 So here's we've got antibiotics, loop diuretics and chemotherapy that when we slipped in a question on you remember this.

30:51 The nurse assesses a client receiving cisplatin.

30:55 Which question is most important for the nurse to ask.

30:58 Now these are assessment questions. So on test questions and clicks questions.

31:03 What they're looking for is, do you remember what would be a sign that this particular patient in this particular setting that they're in danger? So the nurse assesses a client receiving cisplatin.

31:14 That's what we know is particular about this patient.

31:17 They're getting the drug cisplatin.

31:20 Now when you're taking this question what if you have no idea what cisplatin is.

31:25 Oh my goodness that's going to happen to you.

31:27 Okay. I say this again and again.

31:31 Don't let it throw you.

31:32 It's such a mind game when you're taking a high stakes test.

31:36 Whatever it is you're like, oh my.

31:38 And this is what I would normally do. I don't even know what that drug is. That's it. I'm not going to pass. I'm going to be the one. I'm going to be the only one in my nursing school that doesn't pass this test. My mind can go south very, very quickly, but if you can keep your head about you and don't let your mind say those ugly negative things to you.

31:55 Let me show you what you do.

31:57 Now. If you know cisplatin and you remember it, you could say, okay, the question that's most important for me to ask is the one that keeps the patient the safest.

32:06 Okay. So whenever you see that last part of the stem, which question is most important for the nurse to ask? No matter what the question is, it has to deal with the topic of the question. So do me a favor.

32:20 Um, you can write that out.

32:22 Like when you see most important to ask, it's always dealing with safety.

32:28 So when we see something that says what's most important to ask, then that means the question that will give us information about safety for this particular patient. Only thing I know about this patient is that they're on cisplatin.

32:45 So they say I have no idea what cisplatin is.

32:48 What do you do. Well let's look at our options.

32:51 We've got have you noticed any changes in your hearing.

32:54 Well that would mean I think cisplatin goes against your hearing.

32:58 What about do you often awake during the night? That might mean cisplatin messes with your sleep.

33:04 Or maybe you're getting up to pee. Is there swelling in your feet or legs? Mm. Well, that would be a sign that their fluid volume overloaded.

33:12 Or are you experiencing any joint pain? Well, that could be from inflammation.

33:19 Honestly, if I have no idea what this drug is, there's not a clue for me in the sentence.

33:24 Here's where I'm going to save you some grief on the test.

33:27 You have to pick the one that you feel the best about.

33:30 All right. I feel like I have absolutely no idea.

33:34 Because normally what I recommend is that you eliminate the answer choices one at a time, until you get down to the final answer and you say why that one is correct or why those are incorrect. But on this one, if I didn't have any idea, tell me in the chat. If I stay on this question and just keep reading it, reading it, reading it, and I don't know what cisplatin is and I can't tell from the cues.

33:58 Is this wasted time to get stuck on this question, or should I stay here longer? So I've looked at the question. I know what it is. I look at the answer choices.

34:07 I have absolutely no idea what this drug is.

34:09 You tell me in the chat. Is it wasting time to stay here, or should I just keep reading it and rereading it and rereading it and rereading it? Yeah, it's wasted time.

34:19 You're right. But I am a high stress answer chamber.

34:23 Is anybody an answer changer like you pick a and then you talk yourself into B, and then you want to talk yourself into C and then you want to. Yeah okay. You're my people. You are my people.

34:32 When I say take a test on a scantron, it was a piece of paper that you had to color in and you could change your answers.

34:37 I mean, I love it. Raise a hand.

34:39 You could. I would like, erase my answer so many times when you when I handed it in to the teacher at the end, it would be like, see through. I'd just rub the paper raw and I break out into flop sweat.

34:49 When I have to submit the answer to a question or submit the answer to a whole test. So we'll help you work on that a little bit.

34:56 But I love your answers.

34:57 When you said do your best and move it on, tell yourself it's a mantra.

35:01 Figure out what you're going to say to yourself. It's only one question, right? And if you know me, looking at this longer is not going to do any good. Move on, because the longer you stay here, the more frustrated you get.

35:13 Now, we all know, since we went over it, that the correct answer is, you know, right there, right? It's have you noticed any changes in your hearing? Because we know that it is Ototoxic.

35:25 Now, when you're studying, when you're reviewing, those of you that are getting ready for any type of test, it's really a good idea to have a notebook of fun facts, things that you write down from this question.

35:36 If I looked at it and I was like, I don't even know what this plan is, I would write in my notebook, cisplatin ototoxic.

35:44 All right. When I go back and review my notebook on a regular basis, I ask myself two questions.

35:50 Ready? Why would a nurse need to know this? How would it keep a patient safe? So why do I need to know which drugs are toxic to organs so I can watch for those organs having trouble and collaborate with the physician to address the dosage, or turn it off, or not take any more of it.

36:10 So we're learning a lot more than just pharmacology today.

36:14 We're giving you the tips and tricks for test taking.

36:17 They're going to help you raise your test scores.

36:20 So things that we've talked about make sure you look at pharm not as individual drugs.

36:25 Learn them as families and categories.

36:27 Make sure you know which drugs are toxic to an organ or system.

36:31 When you're reading a question, when it asks you which one is most important to ask, that means which is the one that will keep this particular patient the safest? According to that topic of this question.

36:44 And this one was this one.

36:46 So if you got it right, it is time for your victory lap.

36:49 So you write in the box.

36:51 I got it right. Um, let us know because we want to celebrate with you.

36:55 Ready? So I know some of you out there got it.

36:57 Even if it was random luck, I don't care.

36:59 We're not proud. You just take it.

37:01 Woo hoo! Yes! It feels great, doesn't it? Awesome. Okay. If you didn't get it right this time just wasn't your turn.

37:09 No big deal. We're going to give you skills and strategies.

37:13 That's what matters today.

37:15 Not how many you got right or wrong.

37:17 But you walk out of here with the power tools that you need to keep preparing, and we'll help you on the content.

37:24 So now we're going to look at Bedford kidneys.

37:25 Nephro toxicity and nephro means kidneys right.

37:30 So another 62nd overview.

37:32 There's some antibiotics that go after it. Oh look some of those look familiar.

37:36 Ace inhibitors can be really hard on your kidneys.

37:39 Nsaids. Those are nonsteroidal anti-inflammatory drugs.

37:44 Right. They're kind of in that aspirin family. Uh radiocontrast Contrast media.

37:48 Hey guys, this one, if you don't know, is absolutely like you need to know it because patients on metformin, if we send them down for a test where they have to get this contrast dye for the exam, then that'll go down to like the radiology department to do it. If they've taken metformin within a few days of them receiving that dye, it could severely damage their kidneys.

38:12 So anyone that has a test with radiocontrast dye, we always ask them, you check are they taking metformin.

38:17 Have they taken metformin.

38:19 We make sure that they've held it.

38:20 So usually 2 to 3 days before.

38:23 We don't want you to take your metformin in 2 to 3 days after so your body can get rid of it. So that is a super killer way to ask you a question.

38:31 Right. They're going to see did you ask a patient if their did you review their meds.

38:36 Are they on metformin.

38:37 Have they held the metformin.

38:39 It's just a way that they can do it.

38:41 Yes before and after the reason 2 to 3 days.

38:44 The reason is they want to make sure none of it's in your system before they give you the dye. And then after the dye, it takes a while to get it out.

38:51 Get rid of the dye and everything from your system. And that's why.

38:55 So you're also going to need a plan for something else for their blood sugar during that time. But that will be working with the health care provider.

39:03 Now lithium salts, that's another group that can be really hard on your kidneys.

39:07 And hey, there's your friend.

39:09 Well, not your friend, but cisplatin.

39:11 There again. Now that brings me to a topic.

39:14 When a certain drug has multiple multiple damages then multiple organs that it takes out, that's really important too. And I'm going to give you a tool for that. So we've also when the kidneys are not doing well we just talked about ears.

39:29 And that will just be by sound and how they can talk to you and what they can contribute to you. But for kidneys these are the lab values that you're going to look at.

39:38 Now I have good news, bad news.

39:39 Those of you who are taking the NCLEX before next gen, you won't have lab normal lab values listed.

39:46 Those are you taking it with next gen? You will have normal lab values on your exam.

39:51 But either way you want to know how do I assess for a kidney that's in trouble? What am I looking for to see if my kidney is functioning? Now, of course we're going to look at their urine output and what that looks like, what color it is, is it clear, all that kind of stuff.

40:05 But I'm also going to look at lab work.

40:08 So you see it right there I'm going to look for I'm going to look for serum creatinine.

40:14 We've got some normals there.

40:15 But every lab is different.

40:17 So keep that in mind. And then we've got an elevated bun.

40:21 That's an indicator if serum creatinine.

40:25 That tells us the kidney elevated bun.

40:27 That also tells us so remember in pharm you're pulling together clinical decision making I want to see if it's safe for this patient to take this.

40:36 So before I give a drug that is nephrotoxic or hard on the kidneys before I give one of these drugs, I want to make sure that I have assessed the patient's renal function.

40:48 So that's critically important that you are responsible as a nurse, no matter what order is written by an advanced healthcare provider.

40:56 You're responsible because you're the last one to do that.

40:59 Now, Whitney, um, great example for lab values is that I put them everywhere.

41:04 When I'm studying something like that.

41:06 I just need to look at them lots of times.

41:08 And what I don't want you to worry about is this textbook says this, and this textbook says that.

41:14 Isn't that nuts? When you're in a nursing program and the different textbooks have different labs, just pick one.

41:20 Pick one from a text. Um, we can also make that available to you on our site. But you're looking I like it.

41:29 That is great. Christina.

41:30 I remember, um, like, it cost 7 to $20 for a burger Chef.

41:35 Kiss to you. Beautiful.

41:38 That's what we're looking for now in school, where each faculty sometimes is married to the textbook, and that's allowed values that they use.

41:45 Nclex is going to use values that are outside of the normal ranges, right? So don't get worked up about that.

41:53 Learn one and you got it.

41:54 And pretty much what I say is what I say.

41:56 What I recommend is hey, if we're if you haven't learned a value yet, you're welcome to use these.

42:02 If you have, don't relearn something because then your mind just gets befuddled and confused. So that's definitely what I would recommend now.

42:09 Bad for your liver. Okay, antihypertensives like are on this sheet when you're looking at these, you've got a list of drugs for you. They're just list one. Tell me in the chat one of these drugs that you've seen on other toxicity slides. So looking at this list right in the chat, what are some drugs that we've seen on any other.

42:33 Good. Yeah. Come on. There's others.

42:36 See what you can remember.

42:41 Yeah. Okay, so I'm not just drilling you so I can take a drink of my Diet Coke or Diet Mountain Dew. I'm really want you to role model.

42:52 This is what you do when you study a little bit of information.

42:55 Stop. Ask yourself a question.

42:57 A little bit of information. Stop and ask you a question.

43:01 We know with the research that would bore you to death, but I really geek out over it is if you will pause and recall and ask your questions, your chances of remembering that information will exponentially go up way better than random highlighting or reading or rereading all those things.

43:19 So yeah, these are the things that are going to give us trouble with our livers.

43:24 Acetaminophen that's also known by Tylenol.

43:26 Um, sometimes people have inadvertently or accidentally taken a Tylenol overdose because it's in so many over-the-counter things.

43:34 But these are the drugs you want to be aware of.

43:38 Now we talked about. Oh, this should be sorry.

43:40 This. We're still talking about the liver. Sorry. We have we have the wrong title up there. I promise this is still liver.

43:46 But remember, when my liver isn't doing well, how does the patient feel? Well, before I went to nursing school, I could just go to the mall or to the.

43:54 Nobody goes to the mall anymore.

43:55 But I could just go to a store and just see people and be fine.

43:59 Now when I go, I'm like, ooh, wow, sir, does anyone talk to you about your liver? Because you look at them, they look kind of yellow and they've got some external signs and they their bellies are kind of big, but their arms and legs, so they look like a, you know, they, they kind of look like a olive on a, on a toothpicks. They just look like this little round piece.

44:19 They're almost like what people do with corticosteroids, but they put on a sides.

44:25 So that's why their bellies get so big.

44:27 So now wow, it's really not fun when you go out.

44:29 You can't just enjoy people because you like, see that? Oh that looks like some CHF. Oh that looks like liver failure.

44:35 So know that when you start seeing what you're studying in school, that's a good thing. It's just reinforcing what you're doing.

44:41 What's crazy is when you start thinking that you have those symptoms, but this is what we'll be looking for. So in that first box it says unusual fatigue, loss of appetite, pain in the upper abdomen, dark colored urine, yellowing of skin or eyes.

44:55 Alright. So when you see this list of things, I want you to pause and give me one statement that a patient would tell you about these symptoms. You don't have to write it in the chat, but I want you to make up something that a patient wouldn't say. They wouldn't say, well, I believe I have dark colored urine or I have an unusual amount of fatigue and weakness.

45:16 What might be another way that somebody would say that to you as a layperson? What would they say? Okay, so that's an exercise for helping you make that personal. Another exercise that you do with this? Yes, I feel exhausted.

45:31 I'm tired all the time I feel weak, week? Yes. Look for those types of patient statements in a test question.

45:37 You're on it. Okay, now picture in your head.

45:40 Close your eyes and picture. What would somebody look like who's really tired? They don't like to eat very much.

45:45 They've got weird pain in their upper abdomen and they have yellow skin or eyes.

45:52 As you're going through those lists, instead of trying to memorize those lists, go ahead and try and picture it in your head.

45:57 Now, I am not one of those people.

45:59 I do not have enough working memory because some people do these memory palaces and that's fantastic. If you can do it, you do it.

46:06 I can't, I don't I can't keep all those pieces in my mind.

46:09 But I can picture somebody with liver failure.

46:11 Either I've had a patient in clinicals or I've seen them outside or I have a family member, any one of those things.

46:17 The other thing that will tell us about liver function is a lab test.

46:21 So anytime you're looking at organ failure, you're looking at what that does and what a lab work would tell us.

46:25 Here we have Alt and AST.

46:27 Which one is more specific for liver damage.

46:30 Alt or AST? What do you think? Exactly. An easy way to remember.

46:39 It's the one with the L that tells us there's some damage going on to the liver.

46:44 So how could they throw this at us in a test? Well, we know here, right? The types of drugs that can be hard on the liver.

46:51 They could show us lab values and they could show you alt ast.

46:56 They could give you signs and symptoms or a combination.

46:59 That's what you want to be thinking about when you're looking at these lists, not just trying to memorize them.

47:03 How could my faculty, or how could this type of information come up on a test? Like, why would a nurse need to know that these are the lab tests that we do for checking on liver function? How would it help keep a patient safe? Well, I need to know if these are elevated.

47:21 Then liver is taking a hit.

47:22 It's significantly hurting.

47:24 And if the patient has elevated enzymes and is on these one of these medications, That's going to be my top priority and that's what's really hard.

47:34 You guys want to go ahead and vent about priority questions like, you know, like there's more than one right answer on every nursing school question.

47:40 Sometimes all four of them are right. They just want you to pick the rightest.

47:44 Anyone else feel my pain? Has that been frustrating for you when you take tests in your nursing school? Yes, yes. My favorite nursing school meme ever is the one that has four oranges.

47:56 You know, the fruit? Four oranges. And it says in nursing school exams be like, which one is the orangest? Right. That's exactly what it feels like.

48:06 But these are the tips I'm giving you that say this is what you follow up on.

48:09 Let me show you an example. If it was liver failure, and let's say that they were on rifampin and acetaminophen, let's give them the whole thing.

48:19 So um, which of the following statements requires immediate follow up from the nurse? Well, if they say I'm really tired or I have this weird uncomfortableness in my side.

48:32 Those are kind of vague symptoms, right? We would want to follow up, but the one that indicates a patient's safety is if they said they call in and they say, hey, listen, the whites of my eyes are really yellow.

48:44 That tells me it's gotten to the point that is is depositing in the skin.

48:48 The patient is in trouble.

48:50 All three of those examples were indications of liver failure.

48:53 But which one told us it was the worst? Oh, it's gotten to the point where it's affected their skin because anyone can be tired for a lot of reasons.

49:01 Again, it's uncomfortable abdominal pain for a lot of reasons.

49:04 But there's not many reasons that turns you yellow.

49:07 And that's how you can figure out which one is the biggest risk to your patient.

49:13 So when you see questions that are right, know that there's always one that puts the patient at the most risk.

49:19 So you're looking for which option keeps this particular patient in this particular setting the safest. Now, this one is your homework.

49:28 You look for which drugs are on multiple lists.

49:30 What category are they in? Which ones go after your liver? Which ones go after your kidneys? Which ones go after your ears? And this will be a makeup assignment that you can do afterwards and keep recreating this.

49:40 That is my best advice for how do you keep these drugs listed in your mind? But remember, you're also going to have to know how would a nurse assess the function of that system. So again, the question why would a nurse need to know this? Why would a nurse need to know that liver failure looks like this? How would they use that knowledge of liver failure to keep a patient safe? Well, then you'll pick whatever the answer is. You can use that to pick out what's the most important. So these two questions are super important that you look down.

50:12 And when you're going through and reviewing your content, that's what you want to look at. You want to ask yourself intentionally if you're not with the study group, okay, why do I need to know this fun fact? How would this help me keep a patient safe? That's how it's going to come to you in a test question.

50:29 So that's what you really want to do. Now I'm going to talk about we're going to study as you go from here on out.

50:32 We're going to keep rolling through these questions.

50:36 We're going to talk head to toe.

50:37 This is just how my brain organizes it.

50:39 You're welcome to organize it in whatever manner works for you.

50:43 But I start working things from head to toe.

50:45 Look at all the drugs we're going to cover. Sweet.

50:48 This is what we're going over in this course. Because I want you to hit the biggest concepts, right? The most important things.

50:54 So there's a list of all the drugs.

50:56 There's no way I'm reading that to you.

50:58 But I trust me that we're going to go about all of these so basic principles of cancer chemotherapy and, um, Kate and Melissa, if you can answer that question for Brianna, can I give her the breakdown of the class? Let's start talking about chemotherapy. Now, you know what cancer is this part we're going to go through a little more quickly. Because cancer is cells that do not play by the rules. Um, tissue growth and chemotherapy both go after drugs that have high growth fraction. Okay. That means those cells have a high growth fraction.

51:32 They're turning over fast.

51:34 Now if I asked you to what would you predict are there's five main areas we're going to talk about where you see where you see a high growth fraction cells.

51:43 Where would you predict.

51:44 You don't have to write it in the chat. Or you can, but just off the top of your head.

51:48 Where would you think of five areas that are high growth fraction in your cells? Okay, good skin is one of them.

52:02 Hair. Yep. Yeah. Good.

52:06 Okay, now we just used a study technique where you're predicting, um, not like we know the future, but you're predicting that makes your brain ready to hang on to that information even better.

52:16 So when you ask yourself a question, even if you don't know the right answer, you are No problem. You're doing really, really well.

52:23 So let me give you a silly way to remember this, right? And if I'll make noises, sounds, do backflips.

52:28 If it helps, you learn better.

52:30 But it's hair. Gi skin.

52:35 Reproductive or bone marrow.

52:38 Okay. Hair. Gi. Skin. Reproductive bone marrow.

52:45 So I want you to do that several times with me.

52:48 So just put your pencil down.

52:49 Say it with me. Hair. Gi.

52:52 Skin. Reproductive bone marrow.

52:55 Hair GI. Skin. Reproductive bone marrow.

52:59 Now, if we were together, I would have you do it with each other and bounce things off. But I start from top to bottom because it helps me remember it.

53:06 This tells me where if I have a patient that's on cytotoxic chemotherapy, this is where I'm going to see the side effects.

53:13 Now think about what you already know. You knew most of this, but this is how they're going to ask you a test question on it.

53:18 They're going to see if you recognize what's going on in those areas.

53:21 Because, you know, Jai, the thing I would watch for this is one of the two areas that are most important that I think would be most likely to have a test question on is the Jai.

53:32 The cells in my GI tract means everything from this sphincter to the other sphincter, where food exits when my body's done with it.

53:38 These cells can go under all kinds of problems, but usually what we see is what we see. Like a stomatitis.

53:44 They're nauseated, they're vomiting, they have diarrhea. I mean, it just messes with everything. So if I have stomatitis a patient that means I have itis in.

53:53 You have an inflammation in your mouth. Look at that picture that tells you that patient's really going to have a very, very difficult time.

54:01 So here's the deal. If I have somebody who's on these drugs, I'm going to always want to assess their mouth.

54:07 If I have somebody on these drugs, if it's an option, look really closely at that.

54:11 If maybe looking at their mouth will help you keep them safe.

54:15 Nausea and vomiting. I'm going to be worried about fluid and electrolyte balance, just like I would with diarrhea.

54:21 So can you remember the five areas again.

54:23 Let's go back and see if you can do it. Hair GI skin reproductive and bone marrow.

54:30 There we go. Good. Nice.

54:33 You've. Rachel even got the donation there.

54:35 The more you do that, um, I sometimes use hand gestures just to help trigger my brain.

54:39 You don't have to. I mean, I really do, because I could do that even in testing center, because it's real quiet.

54:44 Just can't say it out loud.

54:46 Now, some other toxicities that we have, we've got super charging your memory that we want you to do. So let's do it.

54:53 You just already did it. But see if you can do it one more time.

54:55 Recall without looking at your notes.

54:58 Can you fill this out? My room thinks I'm gaga.

55:02 Yeah. Could you answer these five questions yourself? Tissue chemotherapy targets is blank growth.

55:10 Blank cells. Okay. These are the strategies I want you to use.

55:17 And when you come back with us for session two, we're going to give you even more tips and strategies and help you learn how to do these.

55:23 Yeah, people are going to think you're weird, but you know, might as well get used to it now. All right, let's kick into diabetes.

55:29 But before we do, um, I know we have a shorter period of time today, but I want you to still take a two minute break.

55:38 So I'm going to turn everything off. You take a two minute break. But before you do, I want you to write down three things that you're going to you're willing to try, right? From what we just talked about.

55:48 What three things are you willing to try? Maybe something different about how you take test questions. Maybe it's a fact about something. But three things that you learned, right. And maybe at least one of them.

55:59 Something you're willing to try when you take test questions. I'll see you in two minutes.

56:03 Please come back. I don't want to be all by myself. All right, two minutes.

58:04 Sweet. Welcome back and see you guys are still here.

58:08 Cool. Now, if you needed to stand up, stretch, move around. I would usually recommend a little bit of a break, but we're having such a good time. Or at least I am with you, that I wanted to make sure we cut off a few minutes of that break. But when you're studying, don't do that.

58:21 Make sure you stop. Walk around.

58:23 Stretch. Move. That is great for your brain.

58:26 You need some time to absorb things.

58:28 So remember, if you're enjoying the teaching, you're having a good time. We have lots more on our website, but let's get rolling because we've got more stuff to do.

58:36 So we have already talked about you did ten practice questions.

58:40 You have talked about cytotoxic drugs and the five areas that you may see side effects.

58:45 And honestly guys, if I would guess the reason where the place you're going to see the most test questions are going to be from the oral stuff, the GI stuff, stomatitis, nausea, vomiting, diarrhea.

58:56 And it is going to be the bone marrow because when it impacts the bone marrow, you it goes after the white cells first.

59:03 And that can put a patient really at risk.

59:06 So it goes after the white cells.

59:07 They can't fight off infection.

59:09 It can also go after their platelets, which means they're a bleeder.

59:12 So you want to be careful things with like straight, straight razors and that kind of stuff which you do not want to use on the electric razors.

59:18 And the last one is red blood cells.

59:20 And they are super tired.

59:22 They can get anemic. So that's where I would imagine the most interesting test questions would come on cytotoxic.

59:30 Look in that mouth. See what's going on here.

59:32 Asking about their fluid and electrolytes. Because if their mouth is really terrible, they may not be eating, which means their weight could be changing.

59:39 You get the drill. So we've done that.

59:41 Now let's start rolling through diabetes.

59:44 Now, I would imagine that every one of you on this meeting today, you've heard the word diabetes, right? You know what this is? You know how it works.

59:54 So just enjoy this. Just look at what you already know that the average person on the street doesn't know it's right.

1:00:00 So we know that glucose needs insulin.

1:00:03 And insulin is, as I say, a hormone that is that what helps get glucose from your bloodstream into your body? So glucose can't be used by my body unless I have effective insulin.

1:00:16 That can help it get into the cell so that insulin on the receptor site, it opens up the gate. You see the glucose going in there? Pretty cool. So what's most important that you know about diabetics? I want you to think about the risks of our biggest complications.

1:00:31 Can be the risk from hypoglycemia or hypoglycemia.

1:00:35 Now short term, like in the moment, I'm really worried about hypoglycemia being the most dangerous. But let me break it down for you in the slides so you can see short term what I'm worried about.

1:00:45 Hypoglycemia and hypoglycemia remember hyper means high.

1:00:51 Hypo means low. That is a creepy voice, isn't it? Now, long term, if I have an episode of Low Blood Sugar, an episode of High blood sugar, it's not great, but it's not really that damaging.

1:01:06 However, long term this is what we're looking at.

1:01:09 It damages the macro vascular.

1:01:12 So you've got all this like you can have heart disease and stroke and high blood pressure and hypoglycemia and you don't metabolize your lipids.

1:01:20 Right. So you can have macro vascular damage.

1:01:24 Those are the big things. And then microvascular retinopathy can be damage to their eyes nephropathy.

1:01:30 You've got neuropathy.

1:01:31 So nephropathy you're talking about damage to the kidneys. You can have these horrible shooting pains. My dad had neuropathy and it was like his legs were numb and on fire at the same time as the only way he could describe it to me.

1:01:45 So you see all those things that are listed there, those could be used for you in test questions.

1:01:49 They're going to recognize. Do you recognize that somebody who has difficulty maintaining a relatively stable blood sugar? What are the signs and symptoms we're looking for. This could be a what's most important, the question that you ask somebody to follow up on, that's what we're thinking about. So these are here.

1:02:08 Go back and review them.

1:02:09 Make sure when you see retinopathy just don't say retinopathy.

1:02:12 Say what is retinopathy.

1:02:14 Well that's pathy disease of my retina.

1:02:17 There you go to my eye.

1:02:19 So that's when you go back and review.

1:02:21 And we're not with you having such a good time.

1:02:24 That's what you want to do.

1:02:25 And then ask yourself some questions.

1:02:27 Ask yourself some more questions and keep doing that on a regular basis.

1:02:32 Oh yeah. Wow. At ten years old, I'm so glad what we have available for people now than what we used to.

1:02:41 So this is a key slide.

1:02:42 Know the signs and symptoms of hypoglycemia.

1:02:45 Sweaty. Their head hurts.

1:02:47 Their heart is. And why is it doing that? Because it is kicking the snot out of that, right? All of a sudden your body realizes, whoa whoa whoa I need more energy or we're going to die. So it kicks out the adrenaline, and that's why somebody gets real edgy and real cranky and real hyper.

1:03:03 Because the tachycardia, the fast heart rate, is because the body is trying to tell the liver to kick out stored glucose as an energy source. So if I was getting ready to run, let's say that there was a truck about to hit me and I'd have to take off.

1:03:19 My body says, well, Prof.

1:03:21 Loss needs more energy.

1:03:22 We're going to get that stored energy out of our liver. The same mechanism that gets the stored energy out of her liver also makes her heart go really fast.

1:03:32 So that's why when you have someone with hypoglycemia, they look like they're really stressed out because they are.

1:03:40 But they can also be confused because their brains not getting enough energy to work.

1:03:44 Or they can be really tired and they can't come back.

1:03:46 So watch people with beta blockers, because somebody who has low blood sugar is and is on a beta blocker won't show you the tachycardia, which is usually a classic symptom that we're looking for, so keep that in mind. Remember this is a review.

1:04:02 You can watch in-depth videos on all these topics on our site.

1:04:05 So we're going to keep moving a little quicker.

1:04:07 And you might feel like I can't keep up.

1:04:10 You can't just stay with us.

1:04:12 And also you're going to have this information.

1:04:14 And we also have lots more information on the website.

1:04:17 Now how do I watch for hypoglycemia with increased risk.

1:04:21 This is another important thing to know if someone is on one of the medications that we have listed here, they have an increased risk for their blood sugar to go low.

1:04:31 Now the third one, the third bullet really surprised me.

1:04:33 And it surprises my college students every year. Like what happens if a diabetic drinks alcohol? They really have an increased risk for hypoglycemia.

1:04:43 So if you see a test question talking about someone who's a diabetic and they're on insulin, they're on insulin, on insulin, and they had their out their friends at a bar and they had drink.

1:04:54 Which status is the patient most at risk for? They will describe it to you.

1:04:59 They won't necessarily say, hey, they are out at a bar.

1:05:04 They have ingested alcohol.

1:05:06 Um, they now have. Which will be the biggest risk? Hypoglycemia. Hypoglycemia.

1:05:12 That's not how they test.

1:05:13 They'll say which of the following patient statements most concerns you or which requires immediate follow up? Or what should you educate the patient about? So those are the key terms I want you to be looking for.

1:05:25 Hypoglycemia. Fireside diuretics can raise your blood sugar.

1:05:29 Glucocorticoids even if you're not diabetic.

1:05:33 Glucocorticoids can raise your blood sugar.

1:05:35 So if you're diabetic and you're taking a glucocorticoid, we got a problem. Sympathomimetics.

1:05:41 Remember we talked about when your blood sugar is too low and it starts squirting out the stuff? Neurotransmitters that are going to that are going to tell your liver to kick out stored energy, blah, blah, blah.

1:05:53 Well, if I'm on a drug that mimics my sympathetic nervous system, you call it a sympathetic mimetic mimics my sympathetic nervous system like epinephrine, norepinephrine. That can also cause my blood glucose to go high whether I'm diabetic or not. So if I'm diabetic and on these meds, that's going to be a big deal.

1:06:14 Now, these are the goals that you're shooting for. You've been exposed to those before, but you need to really know that this is kind of what we're looking for in the blood.

1:06:22 Pressure will be likely even lower.

1:06:25 So I would even consider that for a diabetic, we'd want the blood pressure to be even a little lower. Our goal if we want to prevent long term complications pre-meal plasma glucose.

1:06:35 That means they check their blood sugar before they eat. They're shooting for 90 to 32 hours after a meal.

1:06:41 That's also called postprandial.

1:06:44 You want it to be less than 180 when you're taking their blood sugar.

1:06:48 And then we're shooting for a hemoglobin A1C of less than seven.

1:06:52 Okay, remember, that's the test that tells you what the average of their blood sugar has been over the last 2 to 3 months.

1:06:57 We're shooting for less than seven is just a good, good goal. Everyone is different.

1:07:01 Some people can get much lower. Some people struggle and can't get it lower.

1:07:05 But that's a decision will be made with their healthcare provider. Now in this section I'm going to go a little quicker through here because there's a lot of drugs that you can go back and review. The one I would really stress to you spend some time with is metformin. And what organ.

1:07:21 If I'm going to go to the hospital I'm on metformin. What organ is at highest risk if I'm going to go down and have a test in radiology, which organ is at risk if I'm taking metformin? Nice. Good. You're not going to let them catch you on that one I love it.

1:07:36 So we've got these drugs listed out for you here.

1:07:38 There's lots of oral medications.

1:07:40 Some of these you can only take if you're type one.

1:07:43 Some type two patients can also take.

1:07:46 But here's where I want you to really focus.

1:07:48 There's insulin. There's a lot of insulins, right? There's a lot of insulins.

1:07:52 But here's how I want you to organize them in your brain.

1:07:55 Short duration. Rapid acting.

1:07:58 Short duration. Slower acting.

1:07:59 Intermediate duration and long duration.

1:08:02 So let me spell that out in simpler words, because otherwise it just all sounds the same. But short duration means it doesn't last for a very long time.

1:08:10 Rapid acting means it kicks in really quick.

1:08:13 Short duration means it doesn't last very long, but it takes longer than that category right next to it to kick in.

1:08:21 Intermediate means it's in the middle and long is like almost peakless where we are.

1:08:26 So I've arranged the insulins for you like this.

1:08:29 So you can see this meds here.

1:08:32 This one is an example of short duration, slower acting, intermediate and long.

1:08:38 So these are the things I also put the trade names in there, in case that made it a little bit easier for you to remember.

1:08:44 But look for things, um, if anyone's on insulin.

1:08:47 Most concerned about hypoglycemia more than hyper.

1:08:51 That could be more dangerous to them.

1:08:53 This one on the left here, the short duration, rapid acting. I can use that to titrate. Let's say that I have a pump on that's giving me insulin all the time.

1:09:00 If I'm going out to dinner, I can look at the menu, see how many carbs I'm about to eat. I know how my body adjusts to that.

1:09:06 I've worked with my healthcare provider, that type of thing. We do that with patients all the time. Then they can inject themselves with this short duration, rapid acting when they order, and by the time their food gets here, they're covered and good to go.

1:09:21 Okay, so time to supercharge your memory again.

1:09:24 Try to start it now. Don't look at your notes.

1:09:26 Right. Try not to look at your notes.

1:09:28 Can you remember forming categories? Just speak them. You don't have to say them.

1:09:32 What are the main duration and time categories for insulin that we recommended.

1:09:40 Remember these. Okay cool.

1:09:42 It's okay if you didn't just keep going back and asking yourself so you can get all four of these right when you're studying later.

1:09:48 That's a strategy I would recommend.

1:09:51 Now remember with insulin everything used to be only regular was clear.

1:09:54 And you may be young enough into healthcare that you don't remember that.

1:09:57 But that's how it used to be.

1:09:59 But it's important. They may ask you a question about how do you draw up a combination of insulins when you have clear and cloudy? What do you need to do? Sounds like something that a teacher would ask you, wouldn't it? Here's a list of those little more information about those rapid acting insulins. Good deal. So we've got them there and got the information for you, but you can't memorize this.

1:10:22 So on this one, you just recognize this is rapid acting.

1:10:25 I don't try to remember. This one's 10 to 15.

1:10:27 This one's for. This one's 10 to 15. This one's 9 to 20.

1:10:29 You can't do it. You've got too many other important things to remember.

1:10:33 Like the faces of your family and friends.

1:10:35 Then memorizing each one of these, we would look this up.

1:10:39 But by looking at these tiny details as big chunks of a category, you're going to be doing much better.

1:10:45 So same thing here. I just wrote up more details of what we talked about.

1:10:50 This will take some time for you to layer that into brain.

1:10:53 You're not going to do this in a short period of time, but if you've got the time now, start putting those pieces in your mind in those four categories that I recommended for you. Now, remember, when you're mixing insulin, you want to make sure that you don't get any cloudy in the clear.

1:11:09 That's really the best way to remember it.

1:11:11 Um, it's great if you can mix insulins, you can give them one shot.

1:11:15 Um, you only really want MPH with short acting.

1:11:17 The biggest thing is do not get any cloudy in the clear.

1:11:22 So you're going to want to draw up the clear first, not the cloudy couple situations.

1:11:28 I want to look here that things when things get really really really bad diabetic ketoacidosis. So if where's my ABG peeps out there.

1:11:38 What type of if you what abgs would you expect to draw on somebody who's in diabetic ketoacidosis. Is it respiratory alkalosis? Respiratory acidosis. Metabolic alkalosis.

1:11:49 Metabolic acidosis. What would you expect? Nice. Nice. You guys are crushing it okay.

1:11:56 Right. So diabetic ketoacidosis is usually a type one diabetic.

1:12:00 They have super high blood sugar.

1:12:02 They have ketoacids present.

1:12:04 Present. Because when they can't use the glucose in their bloodstream for energy, they go after the fat stores.

1:12:10 That's when you end up with the ketones.

1:12:13 And this is a little different process than if you're doing a keto diet.

1:12:17 Now I've got some listings here of all the characteristics.

1:12:20 I've got more video on exactly what this looks like and how things go down and how we fix it. But I want you to keep in mind that a blood sugar that's really high in a type one diabetic is going to end up in diabetic ketoacidosis, which is an example of a patient will be if you drew abgs metabolic acidosis.

1:12:40 And we've got, um, ABG stuff, too.

1:12:42 It's on the couch. We'll teach you that if you want to, if you're interested. But it looks like some of you are really good.

1:12:47 Now, this is what most often happens with type two diabetics.

1:12:51 This one, DKA. Diabetic ketoacidosis comes on really quickly or can come on very quickly.

1:12:57 This one happens over a much longer period of time, but it's also a very high blood sugar because there isn't enough insulin to help get that glucose into the cells most often type twos.

1:13:10 So it can be building up for a couple months before they really seek health care for this.

1:13:15 Now they are hyperosmolar, so they are just they cannot keep enough liquid in. They're just peeing out everything.

1:13:22 Everything. They, as much as they drink, can't keep it up with themselves.

1:13:25 They're severely dehydrated.

1:13:28 Both have issues of dehydration.

1:13:29 And we'd love to dive into this later, but we'll do that at another time.

1:13:32 Also, I want you to know that we have a discord server.

1:13:36 Super cool. I'm not even cool enough to know what one of those is, but they're going to tell you at the end how to join it.

1:13:41 And we'll be talking more about these subjects on there.

1:13:44 Now here I compared the A to you've got those both there comparing diabetic ketoacidosis to which one is more likely in type one.

1:13:56 Which one is more likely in a type one.

1:14:01 Perfect. So who's more likely to get.

1:14:09 Excellent. Good. Good.

1:14:11 You got it. Cool. So remember, we've just gone over diabetes.

1:14:14 We're going to do the psych stuff next.

1:14:16 But don't forget we have a website with more videos.

1:14:19 And I also want you to, like, come join me on the discord server.

1:14:21 We're going to pop in and do study halls with Prof.

1:14:24 Lawes, so we'd love to have you join us.

1:14:26 And it's free. There's there's no charge to it.

1:14:28 And you just get to meet other cool nursing students. And I'd love to see some people from all different areas.

1:14:33 So they'll give you the, the, um, Link the place that you can go to sign up and just get a little app on your phone, and you can hang out in touch with us anytime. We've also got Nurse Liz on there.

1:14:44 She's super cool. She's a nurse practitioner.

1:14:47 She's a YouTuber. She has like 130,000 people who follow her.

1:14:51 So yeah, she's way cooler than I am.

1:14:54 Now let's take a look at psych meds.

1:14:56 Right. Here's what we're going to focus on how to treat anxiety antipsychotics, antidepressants and mood stabilizers.

1:15:04 So we've got these four categories before we start studying them.

1:15:07 Look away from the screen and see of how many of those four categories can you remember.

1:15:16 Okay. Come back and see what you missed. Look at them again.

1:15:19 Look away. See how many you can repeat in your mind.

1:15:25 Yeah. So before you would go on, if you're studying and I wasn't here, what you'd want to do is say, before I start putting this information in my brain, let me remember, I'm going to be looking at these four types of diagnoses for treating.

1:15:38 So let's move on because that's normally how we look at the different segments is actually by diagnosis, which some of you were rightfully complaining that your textbooks are like that. So let's look at anti-anxiety first.

1:15:48 Now these guys are sedative drugs.

1:15:50 They can usually mess around with the Gaba in your brain.

1:15:52 I've given you examples on the left, and you have both trade and generic names, but the long names are going to be the ones you see on an exam.

1:16:00 We use these for people that have anxiety disorders, and that's a real thing.

1:16:04 That's not just think happy thoughts and you'll be fine. So sedative hypnotics are used for patients who have severe anxiety or panic disorders.

1:16:13 We can also use them for these other two things detox and withdrawal of alcohol, which should never be done at home if the patient is dependent on alcohol and seizures.

1:16:23 All of these medications work on the central nervous system.

1:16:27 That's where anxiety comes from, and that's what we're working on in there.

1:16:31 So anything a drug can do, well, it can do over well.

1:16:34 So stop. You're looking at that whole list.

1:16:37 They're like, oh my lanta, how am I going to remember this? Well, when you look at long things like this or like this is a central nervous system drug, its name is sedative hypnotic.

1:16:48 So it makes sense. If anything a drug does well, it can do over well. It can make them too sleepy.

1:16:53 But some weird things, it can make depression worse. So someone comes in and gets this and they have depression.

1:16:58 This might make it worse.

1:17:00 If you get enough of it, it's going to really jack with your central nervous system and maybe respiratory depression or something else.

1:17:06 But you see what I'm doing? I'm not memorizing a list.

1:17:09 I'm thinking, I know there's four categories we're looking at.

1:17:12 These are psych meds. This group is a we use it for anxiety.

1:17:15 It's a sedative hypnotic.

1:17:17 So of course they could be to sedated or hypnotized.

1:17:20 Right. Um, we know that for depression, we're kind of worried about this if they take it. So it may be a patient who was on this drug and noticed an increase in their feelings of hopelessness or sadness.

1:17:33 That's how it might show up to you on a question.

1:17:35 They may ask you which drug? What else? Orthostatic hypotension, most likely with the I've read I gave it to you here, but I wouldn't be as worried about that.

1:17:44 What I would remember is, oh, if it's a sedative, I might be kind of woo hoo! When I stand up, that will help me there.

1:17:50 Nausea, vomiting, dry mouth.

1:17:51 I mean, that's if they're going through withdrawal.

1:17:54 So we put that in there. Remember looking at head down to toe.

1:17:57 So we did head cardiac.

1:17:58 Now we're doing the gi um dizziness and ataxia.

1:18:01 We put that in mobility but just picture them.

1:18:04 Somebody who's kind of oh kind of look like they're drunk.

1:18:07 Almost no anti-psychotic ones.

1:18:09 These are the ones that get super interesting. Stay with me.

1:18:12 But before we do, what group of medications did we just talk about? What group of psych meds did we just talk about? Yes, Laura. For the win.

1:18:25 Evelyn. Yes yes yes yes yes yes yes.

1:18:28 That's how you're studying.

1:18:30 You're studying with us. And that's how I want you to study when you're not with us.

1:18:33 But remember, we're always available.

1:18:34 Check out our discord. Check out that stuff. But that's what you want to do.

1:18:39 Hours and hours of just having your eyeballs bleed is not going to help you do it.

1:18:42 So let's look at antipsychotics.

1:18:44 Okay. We use these to treat like things like schizophrenia or bipolar major depression.

1:18:50 Sometimes there's some really delusional disorders. And keep that in mind that we are using antipsychotics to treat psychotic symptoms.

1:19:00 And these are a list of psychotic symptoms.

1:19:02 That's what we're looking for. So neuroleptics it's a really cool name, but that's what that is. Neuroleptics.

1:19:08 Um, this is first generation.

1:19:10 Whenever you see first generation by a drug, that means that's the first group they discovered. Usually problematic.

1:19:17 Usually problematic. Right? First generation. They're not super good. And there's some really strange things that happens with this one over here.

1:19:25 This is the second generation.

1:19:27 Now They don't have the same dangers as the first one as much, but they got their own problems.

1:19:32 So let's take a look at these.

1:19:34 Know that there's neuroleptics and serotonin dopamine antagonists.

1:19:38 Now here's some adverse effects of the first generation antipsychotics okay.

1:19:42 Remember these guys are the first ones found.

1:19:44 You can have this weird kind of dystonia.

1:19:47 They can have like some shaking.

1:19:48 So you take people that are having psychotic issues and the side effects.

1:19:52 You have to decide if they're worse, um, taking the drug or not taking the drugs, but akathisia, they can't sit still.

1:19:58 They have they can have tardive dyskinesia.

1:20:02 It's terrible. You wouldn't wish this on anybody.

1:20:06 Those are bad. But if I had a question for a patient taking antipsychotics and they asked me what's most important that you follow up, it's really not those symptoms on the left I'm looking for signs of neuroleptic malignant syndrome.

1:20:21 Okay. That's going to kill them.

1:20:23 Yes. I don't like the anticholinergic. Remember? Dry eyes.

1:20:26 Dry mouth. Can't see, can't spit, can't pee.

1:20:29 You have urinary retention and can't poop.

1:20:32 But there's another word that rhymes with that's not appropriate to use. So neuroleptic malignant syndrome is life threatening.

1:20:40 Anticholinergic effects not so great.

1:20:42 It's not life threatening.

1:20:44 Orthostatic hypotension could increase your risk of falls.

1:20:47 Not life threatening. But we want you to know that neuroleptic malignant syndrome is when they could die. And the sign of that is lead pipe rigidity.

1:20:58 They will arch their back. Their muscles get really stiff.

1:21:01 It's excruciating for them.

1:21:02 And it can end up in death because it just wears them out.

1:21:06 It's usually respiratory failure. So those of you that are going to work in ER, you'll find people with this, you'll see them with this. So first generation the worst thing that could happen is any neuroleptic malignant syndrome.

1:21:20 Everybody with me okay.

1:21:22 So make sure you've written down Known names.

1:21:24 And I want you to say what is one sign and symptom? What would they look like if they're experiencing neuroleptic malignant syndrome? You don't have to tell me. He just got it. Cool.

1:21:39 Yep. Nms. I like it, I like it.

1:21:41 Arch back. Rigidity. Good.

1:21:43 Nice. Now type two. Right.

1:21:46 This atypical ones. They have some of the same things.

1:21:49 Like they don't have as much of the dystonia, the Parkinson's shaking and akathisia and the tired of dyskinesias.

1:21:56 Here's the problem. Two things.

1:21:58 They can have bigger metabolic risks like they call it metabolic risk, like weight gain, diabetes, difficulty with their lipids being off.

1:22:07 But agranulocytosis can also be a risk that really messes with their blood cells.

1:22:13 So these types of drugs like clozapine, if you see this one, this one can really kill you.

1:22:19 I mean, if you have the severe side effect to it, you got to get a really, really, really life threatening little white blood cell count. So we defined that here.

1:22:27 But know that, hey, this is the second generation, right? What's the biggest risk with first generation.

1:22:34 Tell me in the chat. What's the biggest risk for first generation antipsychotics? You got it. Um, there's a lower risk for neuromuscular.

1:22:42 Neuroleptic malignant syndrome.

1:22:45 Wow. Someone wrote that all out. That's impressive. Laura. There's a lower risk of that with type two. Those those second generation atypicals.

1:22:53 But they carry the risk of severe agranulocytosis.

1:22:58 And they have the metabolic risks.

1:23:00 So I would have just a quick chart remind like type one neuroleptic malignant syndrome.

1:23:04 Lead pipe rigidity is what they call it. Or whatever you want to call it could cause death. So what are the ways that I could die? Taking a first generation neuroleptic malignant syndrome, taking an atypical one.

1:23:16 The newer drugs, it could be a granulocytosis.

1:23:20 Is that a common reaction? No, it is not. So don't think you're going to see that often.

1:23:25 But it is a possibility.

1:23:27 So any drug we give, anything it can do well it can also cause harm.

1:23:31 Just gotta always balance it out.

1:23:33 Such a bummer when our nursing students figure out, oh, so drugs. There's no perfect drug because there is not.

1:23:41 So when you're looking at this right, life threatening muscle rigidity, they have severe symptoms.

1:23:47 Their heart rate goes super fast.

1:23:50 Their blood pressure goes very high.

1:23:52 When they finally took her out, if they don't get treatment, it's from respiratory failure.

1:23:57 And that's what ends up in their death.

1:23:59 This is again rare, but very serious.

1:24:03 So that's the type of stuff that can come up on a question they might ask you.

1:24:06 Like if your patient is showing some of these symptoms, what's the most important question to ask would likely be about what drugs are taking.

1:24:15 Right. So that's how they can take information and flip it on you and ask a question that means why do I, as a nursing student, need to know about neuroleptic malignant syndrome? Well, you need to know because it could kill someone. And how would it help me keep a patient safe? If I can recognize the signs and symptoms, I can get treatment. I can I can contact the healthcare provider.

1:24:35 I can get them the level of care that they need.

1:24:39 Now, this is a question here.

1:24:41 When you looked at this, the nurse provides care for a client in the emergency department. Now this is our last question we're going to do. And then we're going to come on and say goodbye and give you some directions. But stay with me for this one. The nurse provides care for a client in the emergency department who is receiving haloperidol. Which of the following requires an immediate intervention? Well, look at your options. All right, we've got a blood glucose level of 70.

1:25:02 Well, when you see a number high, low or normal, well, that's a little low, right? That gets my attention. Two plus deep tendon reflex. Well, what do I think about that? Go back to that topic of the question.

1:25:16 Right. What we're talking about is somebody who's in an antipsychotic.

1:25:19 That's what haloperidol is.

1:25:21 And which one requires immediate intervention.

1:25:24 Not going to die with the blood sugar of 70.

1:25:27 The deep tendon reflex of two.

1:25:29 No big deal. Temperature of 103.

1:25:30 That's crazy. Um, which one is going to be the biggest problem? Well, it's not the blood glucose.

1:25:36 It's not that we're looking at this.

1:25:39 And the reason we are not just because it's a high temperature, but because we know that this is a sign they're going into neuroleptic malignant syndrome. So we're like really a temperature? Yes. Because of the topic of the question they're looking at.

1:25:56 Do you recognize that an antipsychotic, that one of the signs and symptoms of a lethal response to an antipsychotic is neuroleptic malignant syndrome.

1:26:05 And the only option on there that pointed toward neuroleptic malignant syndrome was the elevated temp. All right.

1:26:12 Remember the heart rate would be super high.

1:26:15 So.