Event 9: Pharmacology Crash Course with Prof. Lawes – Part Two (2022)

00:01 Hey, you guys came back.

00:04 That's awesome. If this is your first time, welcome back.

00:07 We got a lot of fun stuff, and I mean it.

00:10 It's going to be fun stuff because I want you to not be anxious about pharmacology.

00:16 I'm going to walk you through the most important things. Hi, Christina.

00:19 Hi. Hi, everyone. Yes, we're at part two now.

00:24 One thing I want to say just before this.

00:26 How many people have heard of discord? If you've heard of discord, would you just type it in the chat for me? So, discord. Has anyone heard of that? Oh, sweet. Okay. Well, guess what we did.

00:40 We started a discord channel for students, so I hang out in there every day.

00:45 Say hello. We're going to have study sessions.

00:48 We're going to do all kinds of stuff.

00:50 So Alicia's going to give you that link and I hope you will join me, because it's just nursing students and me and Nurse Liz hanging out in there.

00:58 So it would be really fun.

01:00 Yeah, I love that. Join us.

01:01 Find your people because I would love to have you there.

01:04 And I'll tell you what, you can ask me any question you want to.

01:09 So even after this session is over, you want to still stay connected.

01:12 You want to ask me questions and it doesn't have to be farm.

01:15 Remember, the only questions I don't answer personally are maternal child.

01:19 But I will find an expert for you that will answer those.

01:22 But pharmacology, advanced pathophysiology, critical illnesses, critical care, ventilators.

01:29 I'm in. So please come and join us because we would love to have you there.

01:34 And we can just talk one on one new aprnfnp you guys.

01:40 Just just say congrats.

01:43 Just say congrats to t just write congratulations in there.

01:48 Yes. That is so cool. You passed a big test.

01:51 Well, let's get going because you're here for pharm and we're going to keep it rocking and rolling all the way through.

01:58 Alright, so what's our goal today? Whether you're studying for NCLEX or whether you're studying for a pharmacology course final exam, you've got this.

02:07 All right. We're going to give you the most important things because NCLEX I don't care if it's next gen I don't care if it's the regular NCLEX.

02:15 Used to be safety is the number one issue.

02:19 So when it comes to drugs, drug names can show up in any category.

02:22 But when it comes to patients like if you're a fancy FNP who just graduated like T, or if you're just like one of us in nursing school still trying to make it through to the end, these are going to be where you see all the questions like, that's me. Big deal. Now they're going to put up a poll for you right here.

02:40 We just like to know, um, how many people, like, if you wanted to if you knew about us.

02:45 Who are you? That's just this keeps the marketing people happy.

02:48 And that lets me keep coming back and doing webinars.

02:51 So if you wouldn't mind, just pop in some answers in there.

02:54 We really appreciate it.

02:56 Um, doesn't cost you anything.

02:57 It can just let us know what you got.

02:59 Oh, I see new people to Lecturio and watching videos on YouTube.

03:04 Yeah, I've never paid.

03:05 I watch videos on YouTube too.

03:07 But then sometimes the commercials drive me crazy and I'm too cheap to pay for the no commercial version. But, um, using the free version.

03:14 Welcome. We love you. And you're just as vital as everybody else.

03:18 And you, rock star premiums.

03:20 Thank you for doing that.

03:21 So remember, sign up to our discord.

03:23 You can ask us any question about nursing school nursing content.

03:28 And that'll be the real people that answer it for you.

03:31 So look at that. Alicia had a really beautiful slide for us.

03:34 If I would have kept clicking, it would have been right there. But this is what discord looks like.

03:39 Wah wah wah. I expected it to be a lot more visual, but it's kind of like Reddit and it's still really cool and great information.

03:48 So hope to see you there.

03:50 I'll be logging on this evening so you'll see me live.

03:53 I'm going to start posting some little tidbits there for you too.

03:56 So here's what we covered.

03:57 In number one, we did a pharmacology pretest right.

04:01 So students have already answered these questions.

04:04 Now we've got the practice questions right there. If you guys want to download those.

04:08 And we're going to be walking through the answers.

04:11 So yep you already got it.

04:12 Like I love it. You guys already knew where to go when the handout came up.

04:16 It's because you're smart. That's you are not just the average bears who are here today.

04:22 Fantastic. I have had a week.

04:25 I don't know about you guys, but I have had a week and I have looked forward to this afternoon when I get to hang out with students, because that's what kind of energizes me and charges my batteries when I get to do that.

04:37 So this is what we looked at from top from part one.

04:41 These are some of the things that we.

04:43 Oh let's see. Uh yep. I'm going to get rid of that so I can see.

04:47 Good deal. Sorry. Clicking with some things on here.

04:50 So we talked about how you should study for pharm farm.

04:53 If you were here last time, do you remember? What is any tip that you can remember about tips that we use for studying for farm? Can you tell us in the chat? So what kind of things? Remember them. That's good.

05:12 As families. Cool. Uh, learn drugs by families.

05:16 Yes. That's the best. That is the best thing.

05:19 Fantastic. Okay, look, during my families watch for any drugs that can take out organs. Yes.

05:27 Families and organs and families. What? Toxic to organs. Okay, you guys, again, you are making my week.

05:34 That's one of the big one.

05:35 No, the key drug toxicities.

05:37 Look at those organs, ears, eyes, liver, kidneys.

05:42 Narrowing down the side effects that everyone should know are the ones that impact safety.

05:47 Are you going to be 100% on the NCLEX or any school exam? Nope. Are you likely to see a drug on the NCLEX that you may not have heard of before? Absolutely. Happens all the time.

05:59 Remember, it's just one question.

06:03 Do your best. Move on and else of that.

06:06 Do you know what that means, Elsa? That means let it go. Like they say in Disney's Frozen movie.

06:13 Now, we talked about chemotherapy. We talked about diabetes and how you should look at insulin by those four categories.

06:18 And it's by how quickly they kick in and how long they last.

06:23 Okay. So those are good frames of references.

06:26 Those four categories that we gave you.

06:29 Now we talked about psych meds.

06:31 Does anybody remember like the worst case scenario.

06:35 The thing that could almost kill you if you're on an antipsychotic.

06:39 Does anybody remember what that was called. And you can use the three letter abbreviation if you want to. You don't have to say the whole thing.

06:47 So what do you got? Let's see.

06:50 Anybody got it? Okay. And need some more answers? Yes. There you go. Oh, Leon, that you spelled that out completely.

07:00 You're a rock star. Neuroleptic malignant syndrome.

07:04 Now, you will typically see that with first generation antipsychotics.

07:09 Those are the ones we found first.

07:10 We. As if I was on the research team.

07:12 So remember the things that they do.

07:14 Ooh. Arch back. Lead pipe rigidity.

07:17 Their blood pressure is going to go super high.

07:19 They're going to be sweating. They are at risk of death if they don't get help.

07:25 So they've got to have some medicine. Get in there. Get in there.

07:28 That's good. They need to have a medication administered when they do that.

07:32 Um, that will help resolve those symptoms.

07:35 Now, with SSRIs and Snris, that's a group of medications that we use to treat depression also.

07:41 We've got the Endriss.

07:43 That's like selective serotonin reuptake Take inhibitors and you've got the different kind of versions of that. The takeaway point from this that I'd like you guys to write down is there's something called serotonin syndrome.

07:58 So it's spelled just like because it is this serotonin s e r t o n I n serotonin syndrome.

08:06 And you're going to see similar effects.

08:09 You won't see the lead pipe rigidity, but they're going to have blood pressure out of control. Just think about that sympathetic nervous system going way out of control.

08:20 So if a patient is on a drug that you recognize from the SSRI family, and they're starting to have issues with their blood pressure and other sympathetic nervous system stimulation responses, so the same things you would see if someone's sympathetic nervous system was kicking into overdrive, the patient's at risk for serotonin syndrome.

08:41 That can also kill you.

08:43 So you want to make sure that you could recognize that as a nurse.

08:47 Now, in an exam question, they'll give you the name of the SSRI.

08:51 Remember you're going to look at those families and kind of look for some things that are similarities.

08:55 I'll give you some more drug name tips at the end.

08:58 Shush. All right. Now that's part one that we have there.

09:01 And you guys that are premium members, you know, you have access to this all on your website too. If you want to take a look at this all again.

09:08 But this is the icon I want you to look for.

09:12 It's a 62nd overview. These are like high yield points.

09:16 If I had a test tomorrow, these would be the ones for sure I would know. And so that's how I kind of want you to look at them. I'm just going to give you like go. I've got 60s to do the most important things about this drug content.

09:28 So let's start with our neuro neurotransmitters okay.

09:32 So this is pretty cool. Here, look, we've got the axon.

09:36 We've got these little sheaths here.

09:37 The myelin sheath, these little neurotransmitters.

09:41 That's what we wanted you to see that the neurotransmitters travel to here, down to here, on to the next one.

09:48 That's just how they pass messages.

09:50 So keeping in mind these are the substances that we're talking about.

09:55 Now, before we make this seem too simple, before we make the treatment of depression seem simple, it's not.

10:03 And it's just not a simple matter of, well, you don't have enough serotonin, so we just need to raise it for what you're doing in testing.

10:11 That's a basic enough understanding, but what I want you to make sure is when you're treating patients, when you're talking to them, that there is not one drug that works for everyone with depression.

10:20 Depression is really complex.

10:23 And the problem is it takes, you know, several weeks before the patient to feel any difference. And that's really hard to hang on if you're dealing with depression.

10:32 So know that we are just talking about how do I survive the test.

10:38 But if you are somebody who's struggling with depression or you know, somebody or be taking care of patients. Know that it's not simple.

10:45 So make sure you encourage them.

10:47 Now let's look at another kind of weird group.

10:49 These are oldies but goodies.

10:51 Tricyclic antidepressants.

10:53 Someone asked me, hey, does this mean there are three antidepressants in one? And I was like, that would be cool.

11:00 But no. So don't write that down in your group.

11:04 That doesn't mean three antidepressants in one, but these guys block the re uptake of a couple of monoamine transmitters.

11:14 Gosh, am I dumb. Who center.

11:18 So here are some examples.

11:20 Here I put both the generic name, which is what you'll see on the NCLEX.

11:26 But some of you are taking other exams where you see brand names.

11:29 So you've got them here.

11:31 And in case you're watching TV and see commercials for some of these brand names, you'll recognize them.

11:36 But on the NCLEX exam you will see the generic names.

11:40 If it's harder to pronounce, that's going to be the generic name, but they usually have something in common to help you recognize them.

11:48 So here's examples of TCAs.

11:51 Now we use it for depression. But here's another thing.

11:54 We can use this for chronic pain.

11:57 So we have kind of a dual usage.

11:59 Remember O beta blockers can be used for tons of things.

12:04 And most drugs many of the drugs have more than one application.

12:08 Some of them are off label use.

12:10 Some of them are not. But for this one, something that's kind of unique about tricyclic antidepressants is that you can use it for chronic pain.

12:18 And we found it to be effective.

12:20 So what's it like when you take one of these medications.

12:24 Well, the elderly really have a hard time with that.

12:27 Now note that anytime we have an elderly person on a central nervous system drug, CNS, anytime you see somebody on a CNS drug and they start showing you CNS symptoms.

12:40 That's when you want to be alarmed. That's when you want to be. It's a red flag to be watching for. So if someone is confused and they're on a tricyclic that's a CNS med.

12:50 That's an easy way to remember.

12:52 That's no bueno. So anytime I see a no sounds, please. Oh, that was probably really loud. Sorry.

13:01 I'll be I'll watch that.

13:02 But sometimes I can't help it.

13:04 They just come out. But I'll try not to.

13:07 But there's a takeaway point on any on any question.

13:10 If you see CNS symptoms in a CNS drug, that's what you want to keep track of, right? That's what you want to know is that's not going well.

13:19 Now this one has some weird things.

13:21 This tricyclic can also mess with your heart.

13:25 So could you remember orthostatic hypotension, arrhythmias, cardiac toxicity? Well, if we were just studying a handful of drugs, you could, but you likely wouldn't be able to remember all those in symptoms, but you can't remember.

13:39 Oh, head and heart. I know it's tricyclics.

13:42 I've got head and heart.

13:43 And that would be an easier way.

13:45 Rather than you trying to memorize all of those.

13:48 I try and group some things together.

13:50 Chunk information. It will be enough to help you answer the question.

13:55 Now, this one has some nasty things about weight gain and it is anticholinergic.

14:01 Now you've probably heard the saying if it's anticholinergic it is dropping.

14:06 It is um ending up with.

14:11 Just dry like dry eyes dry mouth.

14:14 So my eyes dry out. I have no spit.

14:17 My mouth dries out, I have a urinary retention and I'm constipated so can't see, can't spit, can't pee, can't have a bowel movement because I'm constipated. There's another inappropriate word that rhymes with spit.

14:33 And that's how a lot of people remember that.

14:35 But with this tricyclics, we've got these issues.

14:39 Cns, cardiac and then we've got like these metabolic kind of issues.

14:46 So the urinary retention goes right back to the anticholinergic properties.

14:52 So so far you've really got three major categories with this tri which means three tri cyclic antidepressant.

15:03 Okay. So urinary retention we take it at bedtime.

15:07 Because if they're going to retain things you can better to do that at night.

15:12 So these are the three main categories I'm going to click off when I click off this slide. And here's what I want you to do.

15:19 I just gave you three main categories for tricyclic antidepressants okay.

15:26 Three categories there by System.

15:29 See if you can type them out quickly in the screen.

15:31 Just type them out and put them in the chat for us.

15:53 There you go. There you go.

15:55 Now, I'm going to give you a minute to enter that.

15:59 Let me take. Oh, like like like like.

16:02 Okay, good. I love how you.

16:06 I love how you're doing it.

16:08 Jeju. That'll work too.

16:10 Good. Head. Heart. Jeju.

16:12 Whatever makes sense to you. Metabolic imbalances.

16:14 Brilliant. Okay. So what you're doing there is a research technique.

16:19 And for studying that we know is called chunking information.

16:24 So with tricyclics, instead of memorizing those 12 things, you think about anything CNS, anything gi, gi, But you've also got that anticholinergic in there however you want to group those.

16:36 That's what you're going to remember. So take a minute and write that down for yourself.

16:40 But pausing and seeing if you can remember without looking at notes is the best way to make sure you get things laid out in your memory.

16:47 Now we're going into Mayo.

16:50 This is like a hard one to pronounce.

16:52 Monoamine oxidase Mao-a is another one.

16:56 So this is in the nerve terminals we're talking about in the brain.

17:00 So when we inhibit this right.

17:02 If we inhibit monoamine oxidase, anything that has a E at the end is a thing that breaks things down.

17:12 So if we inhibit this substance that can break things down we're going to have more norepinephrine and serotonin available in the brain.

17:22 So the name of this drug it's kind of cool about all these psych drugs we're just talking about. They tell you what they do.

17:30 That's their mechanism of action or how they work.

17:34 So here are some examples of some of the names.

17:37 Now Phenelzine you probably remember that one from the test questions.

17:41 We'll get to it in just a moment.

17:43 But here's what I want you to know.

17:45 If it's got the big red circle on it, this is important because monoamine neurotransmitters, they are the ones that relay signals between the nerve cells.

17:54 And they take care of all important functions throughout the body.

17:58 So if we're going to inhibit this this is what we have a risk for.

18:02 So where are we. We're talking about a group of medications the mouth.

18:09 And these are the ones that help by blocking the breakdown of these mono neurotransmitters. Okay.

18:20 So meliss they're an old drug not used as much as they used to.

18:26 But here's their job. They are the ones the MAOIs block the substances that usually break these apart. So that's not making sense yet.

18:36 Stick with me. So you see the picture there, right? And you see what you have are the little neurotransmitters right here.

18:45 But after the neurotransmitters send a message in the brain, here's what happens. The reabsorbed by a protein called monoamine oxidase.

18:52 So it's a transporter.

18:54 If too many of these are absorbed, you end up with this weird chemical imbalance in the brain. So with this drug, this is one that sometimes they love to test you on. And here's what I want you to watch for.

19:08 If you put MAOIs and someone ingests or eats anything that's aged.

19:15 So it could be an aged cheese, an aged salami, a candy wine, those things have tyramine in them.

19:24 And here's the problem.

19:26 Tyranny is the building block of norepinephrine.

19:30 If someone has a whole lot of norepinephrine, too much epinephrine on board, they're going to be in a hypertensive crisis.

19:38 So if I do it like this with no side effects because I've taken that request to heart.

19:45 So the biggest problem with MAOIs, how to keep your patients safe is to teach them to avoid foods with tyranny.

19:53 Now there's a very long list of those.

19:56 Very long list. So the way I remember is aged foods.

20:00 That's what I remember. Because if I have if I'm blocking the the substances that break down those neurotransmitters and tyramine is a part of that, and I take in more tyramine in my diet, I'm going to be in trouble.

20:15 Because tyramine is a building block of norepinephrine.

20:18 So we got to make sure that we don't have this build up of tyranny.

20:23 And you end up in a an hypertensive crisis.

20:26 So you want to make sure you know the foods.

20:29 Now, what's the trick? We just told you.

20:31 What's the trick? Instead of remembering a long list of food names.

20:35 What should you remember? That means what types of food does it not go well with? Anything aged? You got it.

20:45 So remember Velveeta. Is that a problem? No, because I don't even know what that is.

20:49 But it's not aged food, right.

20:51 That is cheese food or something crazy that we put on it.

20:55 You got it. So now we don't give a lot of them.

20:58 See if you can remember one drug name of an maoi.

21:03 Just one drug name of an me.y.

21:05 If you can't, no worries.

21:07 You can go back and take a look at that later.

21:10 So because this MAOIs stop the oxidase, the oxidase from breaking this stuff down, you're going to end up with really, really high levels and a hypertensive crisis.

21:23 So if in the question.

21:26 Yeah. Medical laboratory student. You're going to learn a lot of stuff. So welcome TC.

21:31 Yeah. Cool. Just sit back and enjoy friend.

21:33 And hey you guys, if you don't know this, people that are in the medical labs of your hospitals, they're really smart.

21:41 They go through a lot of school.

21:43 So they didn't just they didn't just show up there one day.

21:46 They weren't, you know, working in a restaurant one day and then started to work in medical lab. They have a lot of training, so always treat them with respect.

21:54 We make big decisions based on their work.

21:57 So this is the takeaway for me.

21:59 It is all about a hypertensive crisis.

22:02 Here's a listing of foods that you already know the secret.

22:05 You're going to deal with foods that are fermented.

22:09 Now, some of the unusual ones that stood out for me.

22:11 Um, in my circle of friends, we don't eat banana peels, but some people do. So it's it can't necessarily be if you see it on a test question. There is tyramine in that food.

22:23 So what are the odds you're going to see that on the NCLEX? Nobody really knows. But the best way is to think about aged foods and look like oh yeah, fish that's fermented, smoked or pickled is also going to be considered an aged food.

22:40 Okay. So long long lists here.

22:45 Again, no brain can remember this.

22:46 But we just put it there to kind of give you some examples.

22:50 Anything like sauerkraut that takes a while to ferment.

22:53 That's also going to be it.

22:54 So here you go. Which client's statement indicates the client understands the teaching about receiving phenelzine.

23:01 So before I look at the answer choices, I would think which client statement is understands the teaching.

23:08 Which means I'm looking for something that's correct.

23:11 I'm going to throw out the incorrect.

23:14 So let me see what I can throw out first.

23:18 You worked your way through it.

23:20 You said. Why? I'm going to give you about 40s to think through these answer choices and to make sure that you think through the rationale for why they could be right or wrong. So it's been a week since we looked at these.

23:33 I want to give you a chance to do it. I'm going to watch the timer and I'm going to go off camera.

24:00 All right. Good job. Now the reason that A is not correct I eat smoked salmon.

24:09 Well that's not an understanding of the teaching because this is an Maui.

24:13 And you don't want to eat an aged food like that Chianti wine.

24:17 We know that also counts as an aged food, so this person does not understand the teaching. My blood sugar is better controlled now that I'm taking no phenyl phenylalanine does not control your blood sugar.

24:31 D is that the one that means they understand? It is. So what if I'm taking this question and I can't remember what phenylalanine is? So I look at these options.

24:45 Is there some way you can find.

24:48 Look at the answer choices and see if there's some types of clue on this one.

24:52 Minor like the first two are those look like smoked foods, but you would have to know that Phenelzine was an maoi.

25:01 So the reason I'm walking you through this confusion is you can only do your best on that question. And then if it's not getting any better, if you're stuck on a question and you stay there, and the longer you stay there, the more confused you get or the more depressed you get.

25:16 Pick an answer and move on.

25:18 Do your best and move on.

25:20 It is one question. Don't let your mind go south.

25:24 Okay, so we talked about that serotonin syndrome.

25:29 Here's what they have.

25:30 Here's a visual picture for you to do this now.

25:33 They it's a CNS issue right.

25:36 So they have changes to their mental state.

25:38 They can get kind of confused.

25:40 They have those and can have a really dry mouth.

25:43 They might be super sweaty.

25:45 They're going to end up being in shock diarrhea.

25:48 Now we have an error there on the slide.

25:51 We'll get that corrected. That that would be they're running in the really high instead of the low. So a serotonin syndrome what I'm really going to be watching for is that they're heading into shock.

26:04 And they're having this kind of weird response to their muscles. They're having tremors or reflex changes.

26:09 And I know they're on a drug that impacts the level of serotonin.

26:14 Any drug that messes with your CNS system and you end up seeing signs of some stimuli.

26:20 Overstimulation. That's when we're going to have a problem.

26:23 So. Serotonin syndrome.

26:25 You've got the parasympathetic and the sympathetic.

26:27 You guys have studied that a lot.

26:30 Let's do a quick review of the nervous system.

26:32 Remember we call this the central nervous system because it's the brain and the spinal cord that go right down the center of the body.

26:40 That's what you see in pink here.

26:42 What you see in blue, that's the peripheral nervous system.

26:45 So this is sending signals all the way down.

26:48 Now, if you're a wicked smart person and you already knew that, please celebrate because you've learned a lot of stuff and you've worked hard if you didn't. Glad you're here today.

26:58 But if you did, just do a little victory dance that you knew what that was.

27:04 Okay, so this doesn't happen very often.

27:07 Serotonin syndrome doesn't happen very often, but it could be Potentially life threatening.

27:13 So it is a medical emergency.

27:15 If you put mouth, eyes and other serotonergic drugs like other SSRI together, you have an increased risk of serotonin syndrome.

27:27 So I have an increased risk of serotonin syndrome when I'm when I'm on just your regular old SSRIs like Prozac, fluoxetine.

27:34 You've heard those drug names.

27:36 But if I'm in Maui, I don't want to eat aged foods.

27:40 And I don't want to also be on an SSRI and drug.

27:45 Lethal drug combinations.

27:47 Possible drug combinations. That could be a really bad deal.

27:50 I'm going to give you examples of other bad combos that's worth your time because they want to see. Are you recognizing that these two drugs should not be given together so they don't play well with others? Maois are a really old drug and they legit do not play well with others. And this is why if you've got the opioids like Meperidine.

28:11 That was the challenge.

28:12 My eyes don't play well with others, particularly well with other CNS drugs, which would include other antidepressants, TCAs, um, opioids. Those are all central nervous system drugs.

28:24 You can end up in a hypertensive crisis.

28:27 Okay. That is a lot of information at you, right? So what I want you to be thinking about before we talk about the other uses for it is on your notes. What are two things you want to remember about em? Two things that you think most would put a patient at risk about MAOIs.

28:52 Okay. Going to give you a second to do it.

29:02 Okay. So stopping and writing things down, stopping and remembering them.

29:06 Those are things you want to do in studying If you ever wonder why you're so exhausted after coming out of Lecture, it's because you've had information thrown at you straight time. Your brain needs to take a breath.

29:21 It needs a pause. So this will help you remember things.

29:25 If you do that, it will also help mitigate your stress level.

29:28 And sometimes farm can be super stressful for people, so we don't want to take these medications with MAOIs.

29:37 This is a good key slide for you to remember because we don't want to end up in a crisis.

29:44 Okay. So we started with do you remember which type of drug we started with.

29:49 Just kind of close your eyes and try and picture in your mind.

29:52 What was the first group of medications that we talked about? What's the group of medications we just talked about? Okay good. This is recall.

30:07 This is asking you to think back on things as you're doing that you're kind of really getting that knowledge grounded into your brain so you can bring it back up when you need it, when you're doing further studying and when you're getting ready for an exam.

30:19 Now, mood stabilizers are for people who have difficulty, um, with moods. This can be really, um, this is a really difficult problem for patients. Mood stabilizers are used for people who have schizoaffective disorder.

30:33 You may have heard that called schizophrenia if they have a bipolar disorder, which there are different types of bipolar.

30:39 We're just using that as a general category.

30:42 But, um, patients can really suffer from big mood swings.

30:46 They can be really, really manic and then really, really down. So bipolar disorder, manic disorders use mood stabilizers to kind of help them balance things out so they can control impulses.

30:59 And they can really function well with activity day living and make good situations.

31:04 Now this is something I want you to know about lithium.

31:08 Lithium is a really old school mood stabilizer.

31:12 So now think back. Lithium.

31:15 What is one diagnosis that we just saw on the slide that would benefit from a mood stabilizer? Can you think of one mental health diagnosis that could be helped by a mood stabilizer? Good.

31:36 Good. And see how we're, like, moving.

31:38 And then thinking back on the slide and then moving and thinking back. That's what you need to do when you're studying.

31:44 No brain can just you don't want to think about if you're thirsty.

31:48 You do not want to wrap your lips around a fire hydrant, right? You want to just a sip of water? That's what we're doing with putting learning in your brain. Now, lithium. It's this lithium carbonate.

31:59 It's a salt. And it can help some.

32:00 It can mess around some weird messenger systems. But let me tell you why it matters.

32:05 This patient education about lithium is important because lithium can cause, especially when the patient first starts it. They pee a lot.

32:15 So they pee a lot. There's two things I want you to watch for.

32:19 First thing, this drug needs blood levels monitored regularly.

32:23 So if a patient is on this medication, they need to make sure they come and have a lithium level drawn regularly.

32:30 So this will help the health care provider know if the patient is making sure that they're getting enough of the medication, if they're getting too much of the medication, if they've stopped taking their medication.

32:40 They'll know what the blood level. But the good news is, for those of you that start on next gen, all the lab values will be present for you in your questions. But for those of you that are taking it before next gen starts, then you're going to have to make sure that you remember as many lab values as you can.

32:56 So lithium first way it can really danger is it has a really narrow therapeutic window.

33:02 So in order for it to be effective, you have to have a range right in here.

33:07 And the only way to know that for sure is to have blood levels drawn.

33:11 Second thing is super important is that I want you to remember that this can act like just makes someone pee out a ton.

33:20 Anytime I lose a lot of fluid volume, that's problematic because what's going to happen to my blood pressure? If I lose a significant volume of fluid, what's going to happen to my blood pressure? Is it going to go up or is it going to go down? What do you think? Tell me in the chat. Right.

33:40 Blood pressure will go down because you have less fluid volume in your intravascular space, in your veins and arteries.

33:47 And that's why your blood pressure will go down.

33:50 So we want to make sure that patients on lithium dietary stuff that they don't they don't cut out all sodium.

33:57 Now if you're in a place that has a lot of processed foods.

34:01 If you have a lot of drive thrus or a lot of restaurants where people eat, I know particularly in the US, we have such high sodium in all our foods that everyone gets plenty of sodium.

34:11 Low sodium is not a problem here.

34:13 In fact, it's really hard to minimize the sodium people have in their diet.

34:17 But we wouldn't want someone to go on a completely low sodium diet with lithium because they kind of need to replace the sodium as a salt that they're losing.

34:26 So it's a CNS med. So that's why it takes 2 to 3 weeks before it's going to really kick into effect. So if the patient is in a real crisis, there's going to have to be something else, like taking an anti-psychotic with it until the lithium can get to a normal blood level.

34:42 Now you want to take it with food. But here's my theory on that.

34:46 Um, you absolutely cannot memorize every drug that should be taken with food or taken on an empty stomach. Can't be done.

34:54 That's what the stickers are for in the bottles. So don't make yourself crazy about that. The type of dietary or food related questions you should memorize the types of foods that are dangerous if you eat them with the patient who's taking in Maui, you should think about the drugs for Parkinson's disease.

35:11 Some of them cannot be taken with a high protein meal because the drug won't be as effective. Those are the kind of dietary questions, but don't make yourself crazy trying to remember the other things.

35:21 So looking at this list, how would you chunk this information? You don't have to write it in the chat, but just think, how can I take this list of bullets and make it in a way that I can remember and will be meaningful to me? So I'll give you a few seconds to look at that.

35:50 Good. So part of what we're doing today is helping teach you how to study.

35:55 Make up a story about this.

35:56 See if you can look away from your slides when you're studying and and give a whole patient discharge like, hey, Mr.

36:03 So-and-so, you've started.

36:04 Your physician has started you on lithium.

36:06 There's some important things I want you to know to keep you safe while you're taking this medication, and then see how many of them you can remember.

36:13 It's a great way to make information stick in your brain.

36:16 It just takes practice.

36:18 So study as you go. Recall without looking at your notes, do just that. Exercise with lithium.

36:25 I want you to try and pretend that you're talking to a neighbor. You both are taking the garbage out at the same time. You've got 60s to tell them everything you think they need to know about lithium.

36:35 Ready? Go. I'm going to give you 30 while you do it.

36:38 But do it quietly in your mind.

37:09 Okay, now think about your thinking.

37:12 What was easy for you to remember? What parts did you remember together? That's things that you celebrate.

37:19 What did you miss? Go back and look at your thoughts or think about your thoughts.

37:23 I'll put this slide back up here again.

37:25 Was there anything you missed? Then you go back and you review it and come back and do this exercise again.

37:31 You know, 15 minutes later in your study period.

37:35 So giving your time space in between, you try to retrieve things.

37:38 That's called space retrieval.

37:40 But try and answer the question.

37:42 You do it once, then you put it away and you start working on continuing on your studies, and you see if you can go back and answer that question.

37:50 Repetition, especially with a the space in between.

37:54 It is a really cool strategy.

37:55 Now, those of you that hang out in on our Lecturio platform, you know that we have questions for you after every video.

38:02 We've kind of made the flashcards for you, and you can use that spaced repetition where you just answer those questions and if you get it right, you don't see it for a longer period of time. If you get it wrong, you'll see it right away. So spaced repetition is really important in your studies.

38:18 And you can do that at home right with your notes.

38:22 So lithium toxicity remember this is the drug that you need to have.

38:27 You need to make sure that you have a serum level a blood level drawn regularly.

38:32 But here's the question from what you've learned, how does a low serum sodium level increase a patient's risk of toxicity? I told you that you need to keep a normal serum sodium level, but I didn't explain why.

38:46 See if you know. Christina, I love your learning tools there.

38:54 Those are great. And, Laura, you are.

38:56 That's a beautiful typist, man. You you, like took things down phenomenally. Thank you for sharing.

39:06 Yeah. See, and this is kind of stuff we do on discord all the time.

39:10 We share things with each other to help everyone make it through nursing school. So I hope we get that worked out so you guys can join us.

39:17 Here's the deal. If your serum sodium, that would be Na.

39:21 If your serum sodium is low, your body is going to tell your kidneys, hey guys, hang on to sodium.

39:29 Well, because lithium is it's got that salt base.

39:33 Also your kidney doesn't necessarily recognize sodium and a and lithium carbonate.

39:40 So it will retain extra lithium.

39:43 So if my serum sodium level the level of sodium in my blood is too low, my body will trigger. My brain will trigger to my kidneys.

39:51 Hey, hang on to salt and it won't.

39:53 They won't be able to tell the difference between salt and lithium.

39:56 So you're going to end up hanging on to lithium that you should have excreted.

39:59 And that puts you at an increased risk for lithium toxicity.

40:04 So we talked about kind of a weird dietary thing with MAOIs.

40:08 Right. Don't eat with aged foods with lithium.

40:12 They have to keep a normal a normal salt level a normal sodium level in order that they don't risk lithium toxicity.

40:20 Now, this is one of the few drugs that you have to draw a range on.

40:24 It's a lithium is a CNS drug.

40:27 And look at this a sign of toxicity is CNS symptoms.

40:30 So that's again where you can use the rule.

40:32 Hey if I have a CNS System symptom from a CNS drug that is a red flag.

40:37 Now here's a therapeutic range.

40:39 I know every book has a different level, but this is just to give you an idea of what would be a therapeutic range.

40:46 Strange, toxic is usually going to be greater than 1.5.

40:50 And remember, NCLEX is not going to try to trick you by putting it a 10th of something over. They're going to make it fairly significant if they have a lab that's outside of the normal range. Always look and see if that lab work lines up with the symptoms too.

41:05 So if I had something, you know, greater than one, I had it at 1.6. And they have this stuff going on.

41:11 I know my patient's likely getting into trouble.

41:14 Really totally messed with their GI tract, but most drugs can, depending on how sensitive your GI tract is.

41:21 But this can mess with my muscles.

41:23 So all of a sudden I have like this weakness in this coordination CNS drug brain is what tells teaches my body how to move.

41:31 So if I have trouble moving and communicating, getting my muscles to do with all the signals that I'm sending, that's a sign of toxicity.

41:40 So what you want to do is chunk these together.

41:43 So look away I'm going to put it right here, and I'm going to go right back to this.

41:49 Now I want you to think of what are the categories you're going to use to recognize the signs of lithium toxicity in your patient.

41:57 Right. So write yourself a quick note.

41:59 You can put it in your chat if you want, but it's really important that you get it in your note.

42:22 Okay. Now if this is hard for you or some, that's good.

42:27 Learning is in the struggle.

42:29 Learning is in the struggle.

42:31 So if you have to work at something, that means you got it.

42:33 You got it right. So thinking on how chunking this information in your brain works, that's fantastic. Also on the NCLEX someone might they might not say the patient is experiencing severe tremors or the patient seems to be drowsy.

42:49 They may say something like, oh, the patient says, I'm so tired.

42:52 I just, I feel so sleepy all the time.

42:55 That would be drowsiness.

42:57 They may say like, oh, I don't feel like eating anything. My stomach feels really weird. So be on the lookout for patient statements.

43:03 If a patient tells you something verbally, that could be a really important part of the question, so don't miss it.

43:11 Good job. Now let's look at this one.

43:12 Remember this. If you're new this time welcome.

43:16 We'll do this. But Mr.

43:17 Yost has a history of bipolar disorder.

43:19 That's a diagnosis. We know that.

43:21 That is those mood swings.

43:22 Manic and very depressive.

43:24 Even as a general rule, we're not talking about all the different kinds of bipolar. Just taking this as a general rule.

43:30 Now they've been taking lithium.

43:32 Anytime you guys see that the question has been taking.

43:36 Take a breath and pause and say, okay, that's a drug.

43:40 What do I remember about lithium.

43:42 So before I look at the answer choices, I want you to pause and think about 3 or 4 things you know about safety for a patient who's taking lithium.

43:51 Ready? Go. I'll wait.

44:03 Okay. How'd you do? What could you come up with? Hopefully you're not looking at your notes because we know you can read.

44:09 Right. That doesn't help you to read.

44:11 What we want you to do is be able to recall in your mind so you can use it when you need it. So I've seen a diagnosis.

44:17 I paused and thought what that diagnosis was.

44:19 I see a medication. I pause and think about that medication.

44:23 And now the patient has called the clinic to discuss a concern.

44:27 So something does not seem right to that patient.

44:30 And they talking to the nurse working with the healthcare provider. Which of the following client statements is more important for the nurse to follow up on.

44:40 Well, hey, there's a lot of words in this one, but we're really learning some critically important skills.

44:45 And this is what I would teach you if we were doing an NCLEX review together.

44:50 You see a diagnosis like bipolar.

44:52 Always think about what's worst case scenario.

44:54 You see a medication. Think about what's the biggest risk to your patient.

44:58 Now, I know he's called to discuss a concern, but the very last sentence of that question, which of the following client statements is most important for the nurse to follow up on? That means anything that is wrong or unsafe for this particular patient.

45:15 Someone with bipolar taking lithium.

45:17 So most tells me there's probably more than one right answer here.

45:22 I just have to pick the one that puts the patient at the biggest risk for their safety.

45:27 So I get very dizzy when I stand up.

45:30 Is there a connection between lithium and getting dizzy? Well, they can be really low in volume.

45:37 I don't like taking my medication every day.

45:40 Well, I don't like that because we need you to take it every day.

45:44 Uh, my legs don't seem to work right.

45:47 Oh, that doesn't sound good.

45:48 And my mood swings are better.

45:51 Okay, so when I start getting rid of things, I'm going to say my mood swings are better.

45:56 Do I need to follow up on that? No, that's a good thing. That's what we want. So I can get rid of D because that's what I want. I know that B like it's really important that you take your medication, but that's not the worst that we have left.

46:11 So between A and C A could be a volume problem.

46:17 But C is telling us it's a real sign of toxicity right.

46:21 My legs don't seem to work.

46:23 Right. Because thinking back to those signs of toxicity of lithium, you lose muscle control and your legs not seeming to work right is a CNS function right? My central nervous system sends signals out to my peripheral nervous system and my legs not working right.

46:39 Could be a sign of that.

46:41 So that's what the tricky elves who write the NCLEX and probably your exams in your classes. This is what they'll do.

46:48 They're trying to see.

46:49 Can you recognize when a patient makes a statement when it's connected to a safety risk for the patient? Okay.

46:57 So who we talked about a lot of things.

47:02 What I want you to do is again take a quick pause.

47:06 Stand up. Stretch. Take a break.

47:08 We're going to take just a quick two minute break.

47:11 But I want you guys to go ahead and take a break stretch.

47:14 We'll come back and start again on hypertension.

47:17 So see you in two minutes I'll be back.

49:52 Welcome back. So here we go.

49:55 Let's head into pharmacology and hypertension.

49:58 So you probably already know this.

50:01 But remember anytime you see h p e r hyper this means that you have something that's too much. So we've got blood pressure that's too high.

50:12 And again if you know that celebrate it.

50:15 You already knew that medical terminology.

50:17 And you can compare that and put that word hyper on lots of things because that's an NCLEX strategy. If you've studied medical terminology and you come up on something and you don't know what it's talking about, see if you can break the word down, because there's lots of cool things like ostomy, otomy ectomy. Those types of words will really help you guess when you don't know it.

50:39 Now this is the arias and this looks like a super busy slide, so I don't want you to look at like, really? Yeah. We just took a lot of pictures here to explain something that you already know.

50:51 This is what happens when the body senses.

50:53 My blood pressure is too low.

50:55 It squirts out running right, so it squirts out the renin.

50:59 It connects with angiotensin one.

51:01 You end up with angiotensin two, and you've got this whole issue with a really big response in the body.

51:10 So angiotensin two, right.

51:12 We've got that angiotensinogen up there.

51:17 Angiotensin two is a really, really, really, really, really strong vasoconstrictor.

51:23 Right. So it's a really strong Vasoconstrictor.

51:28 So what will a vasoconstrictor, something that causes your vessels to constrict or get smaller.

51:35 What will happen to your blood pressure? If we give you a medication that causes your blood vessels to get smaller, the blood pressure will go higher.

51:46 Yes. Awesome. So when angiotensin two is made right.

51:51 Renin angiotensin and angiotensin one, you've got all this cascade going on.

51:55 Two things happen in your body to raise your blood pressure.

51:58 You end up with really tight vasoconstriction.

52:03 And you also have a stimulation of ending up with some L dasturan.

52:09 So we gave you that really busy picture.

52:11 Let's go back and review it again.

52:12 So you have renin. Now why does renin come out.

52:16 Because the body senses that the pressure is too low.

52:21 So squirts right out of the kidneys.

52:24 Renin. Now this Angiotensinogen is already running around in there, right? Comes out of the liver. So renin plus angiotensinogen gives me angiotensin one.

52:34 Now when I have angiotensin one connects with this right here is known as Ace.

52:39 Then we end up with angiotensin two.

52:42 Now why are we talking about this in farm? Because this can help you understand a lot of medications right.

52:50 So angiotensin two does two things.

52:52 It makes your vessels go vasoconstrict.

52:56 And it secretes a drone that tells your body to hang on to sodium.

53:01 And wherever sodium goes, water follows.

53:05 So I know that because the vessels are smaller, because they're constricted. That makes my blood pressure go up.

53:11 If I have more volume on board because I'm retaining more sodium, wherever sodium goes, water fills. That also makes my blood pressure go up. So if I want to lower your blood pressure, if I give like a direct renin inhibitor, then I won't have all this stuff going on here. If I give an Ace inhibitor right here, I give an Ace inhibitor, then I'm not going to have enough stuff to turn angiotensin one into angiotensin two.

53:38 And if I block these, an angiotensin II receptor blocker, I put a med on that receptor.

53:44 So you see the mechanism of action for multiple drugs just for reminding yourself of what you learned in physiology.

53:50 How does the renin angiotensin aldosterone system work.

53:53 Now usually when I say aldosterone I'll say L just to make it stick in your brain.

53:59 But remember L dasturan is a hormone, right? That's its job is to tell your body reabsorb sodium.

54:07 And wherever sodium goes, water follows.

54:11 So see if you can do that in your mind again.

54:13 The body kicks out run.

54:14 And we end up with angiotensin two.

54:16 What are the two ways blood pressure is raised or elevated when angiotensin two is present? There you go.

54:28 You've got it right there.

54:31 So here's a simple diagram to break that down again.

54:34 The blood pressure elevates due to volume expansion hanging on to sodium and water and vasoconstriction. Now remember angiotensin two is super, super potent. It's really it tightens everything down like you can hang your feet if you've seen it in the critical care units.

54:52 This is 4 to 8 times as strong as that.

54:55 And we use it and our body makes it.

54:58 So understanding how we can end up in episodes of hypertension, we also now know what the names of the medications that we can use.

55:07 Because blood pressure is going to be affected by your cardiac output and your SVR.

55:12 Svr is how big are your veins and arteries? If they're clamped down, pressure is higher.

55:18 If they're dilated, pressure is lower now so you can get into preload, afterload and contractility.

55:24 We're not going to go into those too much here, but the more volume generally means the higher the blood pressure, the harder your heart is pumping.

55:32 That's contractility. That's also going to be a higher blood pressure.

55:37 And we really want to go after these.

55:38 These are the things that help us control your blood pressure.

55:42 Now these should be a reminder to you a review.

55:45 So if it's not no worries.

55:47 You can go ahead and take a look at that. But these are the five ways that we can interact with the things in our body that mess with our blood pressure, that maintain our blood pressure, that sustain our blood pressure. Arterioles are the tiniest little vessels, and they are the control valves.

56:02 So we can go after them.

56:04 We can deal with the bear receptors. You have the medulla oblongata that's in that cardiovascular center in your brain.

56:10 So this is just a reminder for you.

56:12 Now you've done all the hard work.

56:14 Let's start talking about treating hypertension.

56:17 What do we actually do.

56:18 Well first line is to diet and exercise.

56:22 After that, if that doesn't work, if that's not enough, because a lot of people's blood pressure will be lowered if they lose weight.

56:28 But some people are like marathon runners, super thin and fit, and they still have high blood pressure, so that can be problematic.

56:36 So if that doesn't work, we'll try and give them less volume.

56:39 Now what is the name of the medication up there that would give me less volume? So where do you see the name of a of a diuretic.

56:48 That would give me less volume.

56:52 I'll wait for you to type it in the chat. Perfect.

56:59 Okay. Hey, that was my next question.

57:01 I was going to ask you guys to come up with another one. That's right. Anytime you give a diuretic that causes less volume and that should cause a patient to might be really at risk for orthostatic hypotension.

57:12 So remember, when you cause fluid volume to shift as an even exit the body.

57:16 A patient's blood pressure can drop.

57:18 So it's important after you give a drug like furosemide, which is a loop diuretic.

57:23 Check their blood pressure to make sure they're not suffering from that.

57:27 Have them sit to stand very slowly.

57:30 Have them lay to sit also very slowly, because they need to give their body blood pressure time to adjust.

57:36 Now we've got these here.

57:38 You've seen those before. We just want to put them on a slide for reference for you. But we're not going to read through those. Now where does an Ace inhibitor work? Think back in your mind. I'm going to ask you some questions that you ask and answer on your own. How does an Ace inhibitor work? If I'm thinking about the Ras.

58:03 An Ace inhibitor means that I won't end up with as much angiotensin two.

58:07 I'll have some, but it won't.

58:09 But look what it ends in April when you see drugs with the last letters of p r I l.

58:15 That's likely an Ace inhibitor.

58:17 Could be something else.

58:18 No rule is 100% ARBs end in tan.

58:22 Well start tan. That's what you'll see.

58:24 Beta blockers are usually always calcium channel blockers.

58:28 And in pine or pine. So there's four quick rules for you that when you see those generic names that can help you recognize if it's one of these types of hypertensive medications.

58:41 Now, sympatholytic drugs other than beta blockers, that's just a big fancy name for saying kind of stops the action of the sympathetic nervous system. A direct vasodilator takes a vessel that's clamped down and dilates it.

58:57 That means your blood pressure is going to low, because you guys already know when a vessel gets bigger, the blood pressure gets lower.

59:04 Now, a selective aldosterone receptor antagonist means even if that body has gone through the arias right, and you are pumping out the aldosterone.

59:15 You've got a medication on that receptor.

59:17 So your body will not hang on to sodium and therefore retain a lot of water.

59:21 So the name of the drug family will tell you how that drug works and also help you keep in mind what might be a real risk.

59:29 So you've got here the names for Ace inhibitors. Remember that is pril.

59:33 And you talked about how they go there.

59:34 There are some examples for you to recognize.

59:36 Now you use these for hypertension.

59:38 And look we've got a lot of other things here.

59:42 If you're taking a course exam they may ask you about some of these other things.

59:48 Usually it's hypertension.

59:49 But we can also use Ace inhibitors with people who have heart failure.

59:53 We can use it after MI.

59:55 We can use it for nephropathy. We got all kinds of things that we can use it for.

59:59 Here's where you have to recognize.

1:00:01 Do I want to chunk this information together? What can I remember? What things look common to me.

1:00:07 And then know that you likely could see something you don't remember, but it's not going to be the majority of the time it's going to be the exception.

1:00:15 But here's what I remember for side effects of Ace inhibitors and beta.

1:00:20 Remember that when your mucous membranes get all swollen, right? Angioedema, cough and elevated potassium.

1:00:28 So those spell out ace.

1:00:31 Another thing to be watching for with your patients. So a angioedema that's a swelling of the mucous membranes.

1:00:38 The rest of your patient is airway blockage cough.

1:00:41 They have this dry hacking cough.

1:00:42 We used to not treat it. Now we realize that's not good.

1:00:45 So we don't let someone just keep going on and coughing and coughing. We'll switch them to another medication.

1:00:50 If this drug has elevated potassium, a real sneaky way to ask you a question is to say, would you give an Ace inhibitor with, let's say, what's a medication that you guys know that's a diuretic, but it also can cause an elevated potassium level.

1:01:07 So which diuretic causes an elevated potassium level.

1:01:15 Potassium sparing diuretics.

1:01:17 Good, good. Really good.

1:01:20 So in testing world. Now, in real life, your physician or healthcare provider might order that.

1:01:24 But in testing world, you don't want to give two drugs together that have the same side effect that are problematic.

1:01:30 So if an Ace inhibitor causes elevated potassium, we probably don't want to give it with a potassium sparing diuretic.

1:01:37 You got it. So watch for those things in questions.

1:01:40 Now Ace inhibitors have what we call a first dose effect.

1:01:43 They can really drop that blood pressure low.

1:01:46 So it's a good idea to take the first dose at bedtime.

1:01:50 So the first time you take it take it at bedtime.

1:01:52 So that way if you get real dizzy you're already horizontal.

1:01:55 And these are not to be used in pregnancy.

1:01:58 I don't recommend you memorizing a lot of that stuff.

1:02:01 What pregnancy? Not pregnancy. But that's just another thing for you to know that this is a no go if someone is pregnant.

1:02:07 So side effects. What are the oh, what are the things that we have? Headache and fatigue. Hey, any medication that lowers your blood pressure can make you feel kind of tired.

1:02:16 Now we've got the cough.

1:02:17 You got the. Okay, I would narrow this one down to the three that I told you so.

1:02:22 Can you remember the three most important of the many side effects that you'll have with an Ace inhibitor? What word does it spell out? There you go. Now that you got that, it's ace.

1:02:37 Can you remember what the A stands for? Oh, wow. Yeah. You got, like, written all the way out.

1:02:48 There you go. Angioedema, cough and elevated potassium.

1:02:52 You got it. So, guys, please let me give you the freedom that you can't memorize everything and you can't keep everything in your brains.

1:03:00 You just do your best, and your best is good enough.

1:03:04 That's what you're looking for. Because worrying about stuff like I do, I'm a master worrier doesn't do you any good at all.

1:03:12 So let's take a look at this question. You guys, are you guys already got that? Spironolactone is a really long word to say.

1:03:20 So the nurse assesses a client who is taking spironolactone, which is a potassium sparing diuretic.

1:03:27 Now they're taking it daily.

1:03:29 So I'm assessing a patient who's on this potassium sparing diuretic daily.

1:03:33 The health care provider has just ordered captopril.

1:03:37 Which action is most important for the nurse to implement? Now, what are these adverse effects I remember about spironolactone, what I remember about captopril.

1:03:47 Do I remember anything else that I'm worried about? So which action is it most important for me to implement? Um, assess the client's heart rate? Well, spironolactone doesn't directly impact the heart rate.

1:04:01 If they're too low on fluids, and it might, their heart rate would be up.

1:04:04 But that doesn't seem like the most important.

1:04:07 I'm going to get rid of that one.

1:04:10 Oh, take the first dose at bedtime.

1:04:12 Does that have anything to do with, um, an Ace inhibitor or a diuretic? Oh, it could be the Ace inhibitor. So I'm going to keep be in assess the client for any history of GI bleeding.

1:04:27 Well, do we know that that has any connection to spironolactone or Ace inhibitors.

1:04:32 And then I've got auscultate the client's lung sounds.

1:04:36 How many of you got this one.

1:04:39 This is what it is. Listening to lung sounds is really good.

1:04:42 That's a good plan, but I'm looking for the answer that keeps my patient the safest.

1:04:47 Should I listen to the client's lung? Sounds? Absolutely. You should.

1:04:51 Right. That's a good thing.

1:04:53 But does listening to their lung sounds keep them safer than making sure when they just started, they just ordered captopril.

1:05:00 We want to make sure they take the first dose at bedtime.

1:05:03 That sounds like a very nursing class kind of thing to do, but that's what you're looking about because they have that first dose effect.

1:05:10 Okay, now tell me how you're feeling.

1:05:13 Oh, Timothy. You want them to take it at bedtime because first dose effect is their blood pressure can drop really low.

1:05:20 So if they take the medication and they go to bed, they'll be laying down flat and safe.

1:05:26 They won't fall if they're not at bedtime.

1:05:28 They're up walking around. They may really increase their risk for falls and hurting themselves. All right.

1:05:34 Now what can you record? What what can you remember from what we've talked about from our two minute break till now? See if you can come up with four key pieces of information.

1:05:45 Ready? I'm going to give you 30s.

1:05:47 Go.

1:06:15 All right. You guys are really doing well.

1:06:17 It's hard to hang with all this.

1:06:19 You're doing well. So on this one, we're talking about ARBs, angiotensin two receptor blockers.

1:06:25 They end in tan. So if we block those receptors then we'll have lower blood pressure okay. So angiotensin two as we say is all dressed up but no place to go because when angiotensin two tries to get to its receptor so it can cause that vasoconstriction, the tan drugs olmesartan, telmisartan, irbesartan, losartan is already there.

1:06:50 And when angiotensin two can't connect to a receptor, you're not going to have that really potent vasoconstriction.

1:06:56 So that's how angiotensin two receptor blockers work.

1:06:59 And they end in tan. Now side effects.

1:07:02 Okay, so. Angiotensin II receptor blockers.

1:07:05 They're still part of that. Arias.

1:07:07 But the cool thing is they don't have as much of a risk for cough, and they don't have the increased risk of potassium.

1:07:14 So you can compare ARBs to ACS.

1:07:16 And that is a way for you to remember.

1:07:18 Okay. So ARBs to ACS. There you go.

1:07:22 Now. Oh we're getting closer to Christmas time.

1:07:24 I can hardly wait. Most of these end in olol.

1:07:27 You've got an a lull there too.

1:07:29 But these are beta blockers.

1:07:31 This is a medication that hooks on to the beta receptors.

1:07:35 Now I have beta receptor ones and beta receptors two.

1:07:40 Does anybody remember where the beta one receptors are.

1:07:44 Where are the beta one receptors located in your body.

1:07:47 Yes Evelyn Hart okay. So here's another one.

1:07:50 Where are beta two receptors located.

1:07:52 Oh Christina for the win.

1:07:55 She already got it. Brilliant.

1:07:59 Good. Good. Good job. So fun.

1:08:02 Okay, so how these guys work is they stop that sympathetic nervous system from being stimulated because they block those beta receptors.

1:08:09 Those beta receptors have to have be triggered, right? That'd be like things like epinephrine have to connect with that beta receptor.

1:08:16 And that's what causes your heart to pump faster and harder.

1:08:20 So now what you want to do is make sure that you're thinking beta blockers.

1:08:26 So I'm going to have less of that.

1:08:27 My heart rate is going to be slower.

1:08:29 My blood pressure is going to be lower.

1:08:32 So beta blockers slower and lower.

1:08:35 That's our deal that we got going there.

1:08:37 So we talked about one heart two lungs beta.

1:08:41 Once you have one heart beta two you have two lungs.

1:08:45 And that's a really easy way for you to remember that.

1:08:48 So if it's a nonselective drug that means it blocks both beta one and beta two.

1:08:54 So if it's a nonselective drug, it. It hits beta one here and beta two here.

1:08:58 If it's selective, we're usually just running and gunning for the heart.

1:09:03 So when you say a respiratory drug, there are certain respiratory drugs that we use to help open in bronchodilators.

1:09:10 But what we're talking about are the beta drugs, the adrenergic blockers that we use to slow and low, slower heart rate, lower blood pressure.

1:09:19 That's what we're looking for.

1:09:21 So use them. If somebody had an MI.

1:09:24 Remember angina or chest pain is ischemia.

1:09:26 It's telling you that your heart's not getting enough oxygen. So if we slow the heart rate down, they will not need as much oxygen.

1:09:33 We use it for hypertension because if you slow that heart rate down and it's not pumping as hard, you're going to have a lower blood pressure.

1:09:40 Somebody with cardiomyopathy, this will decrease their workload.

1:09:43 And if they've got some weird ventricular dysrhythmias because beta blockers directly lower somebody's heart rate.

1:09:50 Now we can also also use them to all of these kinds of things.

1:09:54 So that's a lot to remember.

1:09:56 I would think anything that makes your heart rate go super fast or decrease the workload of the heart. Those are going to be your two most important things.

1:10:04 This is the drug I recommend to students with true test anxiety, not the uh oh. I didn't study my I didn't study for this.

1:10:13 I'm real excited. I'm real anxious.

1:10:15 These are people that they're anxious whenever they take a test.

1:10:18 I just had a student switch to this.

1:10:20 Try a low dose beta blocker.

1:10:22 Worked beautifully. She did great on the test because she was able to think and take credit for everything that she did.

1:10:29 So an easy way to remember beta blockers.

1:10:31 Low and slow. Anybody that needs their hearts taken a hit, they kind of need a break.

1:10:36 And for people who are maybe really anxious, their heart rate's going super fast.

1:10:40 So some of the side effects you've got them here.

1:10:44 What's different about this.

1:10:46 Well know that you can if someone has asthma and they start having shortness of breath, that is a sign that they need follow up immediately, and they need to not continue to take their.

1:10:56 Their beta blockers. Remember there's beta receptors on the lungs.

1:11:01 So beta blockers and breathing problems are bad news.

1:11:07 Beta blockers. Breathing problems.

1:11:10 Bad news. Now we're just flipping through a review.

1:11:12 Here we've got full videos on the site if you want to take a look at them. We've got a lot.

1:11:15 On YouTube too. But beta blockers and breathing problems are bad news.

1:11:21 They should stop taking it.

1:11:23 Kind of an unusual thing here is it can cause impotence, which is a compliance issue.

1:11:27 But. I'm much more worried about someone with asthma having issues with asthma attack because they're. On a beta blocker.

1:11:35 So we want to teach them to check their pulse, let you know if they're short of breath. And if they're diabetic, it's going to block a fast heart rate.

1:11:44 So if you want to make sure the patient.

1:11:46 Takes their pulse. And the magic number on NCLEX is you want it between 60 and 100.

1:11:52 If it is less than 60, you hold the medication and contact the health care provider, and real practice physicians order much lower heart rates. But that would have to be a very specific order.

1:12:03 Shortness of breath. Why? Why does a beta blocker if it's causing shortness of breath? It's about the location of beta receptors.

1:12:12 What organ are we talking about if they're short of breath. Oh it's lungs.

1:12:17 And if a beta. Good job.

1:12:18 If a beta blocker is blocking the receptors on the lungs that allow it to bronchodilator, that's why it can exacerbate shortness of breath.

1:12:28 So that's why I think how does a blood pressure medication give people problems with breathing? Beta blockers.

1:12:34 Breathing problems. Bad news with diabetes.

1:12:39 You could miss the sign of low blood sugar.

1:12:41 Tachycardia is a symptom of low blood sugar.

1:12:44 And if you are taking a beta blocker, you may not have a pulse rate.

1:12:49 That changes very much because you're on a beta blocker.

1:12:51 Remember, beta blocker is low and slow.

1:12:55 So these are three areas where you could have some test questions come from.

1:13:00 Like did you teach your patient to check their pulse. Do you check their pulse before you gave them a beta blocker? Do you instruct them that even if you're not asthmatic, if you have any breathing problems on this medication, contact us and diabetes.

1:13:12 Make sure they know that you will not feel that fast. Heart rate or we won't see a fast pulse rate if you have low blood sugar.

1:13:18 Also, without that sympathetic response, you don't.

1:13:22 Your liver doesn't get the message to put out as much stored sugar.

1:13:25 So it's kind of a double whammy.

1:13:28 Now calcium channel blockers got these listed here.

1:13:31 Tell me in the chat what group of medications did we just talk about? What group of blood pressure medications did we just talk about? What family. Sleep. What family did we talk about before? Beta blockers. Good. Good.

1:13:51 Ace. Good. Good. They end in April.

1:13:53 Look at you guys working together.

1:13:56 Now, which group of drugs end in tan? Arbs. You got it. Excellent.

1:14:04 Good job, guys. Now, here's the calcium channel blockers. These guys can all do some kind of different things, but essentially, these guys will slow down your heart rate too. But they specifically dilate the coronary arteries.

1:14:16 So the calcium channel blockers don't work on veins but they specifically dilate the coronary arteries. Right.

1:14:22 So that's a beautiful thing.

1:14:24 We can use calcium channel blockers for long term treatment.

1:14:27 Plan for chest pain. So these are good things.

1:14:31 That's why one of the ways risks that we use this for to help the patient have better blood flow to their heart in addition to lowering their blood pressure.

1:14:39 So you have increased vasodilation.

1:14:41 Vessels are getting bigger. Some of these will directly take your heart rate down some of the calcium channel blockers.

1:14:47 It's not going to have to work as hard because they've got, um, prevent things from constricting.

1:14:55 Wow. That is a lot of content.

1:14:57 Have you ever just been studying and said, like, okay, my brain is melting, it's on fire.

1:15:03 That's when it's good.

1:15:04 Take a breath, stretch, do whatever you need to do to kind of reset your brain and say, okay, where am I? Ah, I'm talking about calcium channel blockers.

1:15:16 What's different about calcium channel blockers than the other medications that we've talked about? Well, they mess with the calcium channel that's in the name. But oh yeah.

1:15:26 These directly what they directly improve the blood supply.

1:15:30 They dilate those coronary arteries to really get better blood supply to the heart.

1:15:36 Another question you could ask yourself is how do beta blockers help the heart? How do calcium channel blockers help the heart? So those are good practice study questions for you to do.

1:15:46 Now the fourth bullet point I put it in there, but it's really not the most important. But I want you to keep an eye on it. It's about controlling vasospasms.

1:15:54 You may or may not use that, but if someone's having cerebral vasospasm, that is an effective drug for it.

1:16:00 I would look more for long term treatment of chest pain and treatment of blood pressure.

1:16:07 So we've got these right there.

1:16:09 We told you how they can be used.

1:16:11 Try not to memorize which one is for which.

1:16:13 That's just not worth the space.

1:16:15 You can always look it up when you're a practicing nurse. Now the side effects are going to look the same to you.

1:16:20 Okay? These look. Really? Oh, that's way too fast.

1:16:23 Let me go back for you.

1:16:24 Here's how you group these.

1:16:26 Um, and blood pressure medication.

1:16:29 Headache can be a problem just from lowered blood pressure.

1:16:32 You have dizziness and weakness. These are all pretty general, but right here, orthostatic hypertension.

1:16:37 Yeah. These are going to be the ones that I check on.

1:16:41 This is going to be the one. That's the biggest sign of danger to me is with a calcium channel blocker.

1:16:46 When they start having some heart dysrhythmias. Calcium channel blocker.

1:16:50 They start having some heart dysrhythmias. Calcium channel blocker.

1:16:53 They start having some heart dysrhythmias.

1:16:55 That's going to be the most important piece for you.

1:16:58 So we already did study as you go. We're ready to go. We're going to talk about some other meds and the cardiovascular system.

1:17:03 Now remember this drug.

1:17:05 This was a patient receiving digoxin.

1:17:07 Which statement made by the client would require the nurse to intervene.

1:17:11 Okay. So what's particular about this patient is they're on digoxin. What would have them intervene. Well is a a problem of toxicity is be a problem.

1:17:23 Be unsafe is c is D. Well as you were talking through these GI disturbances GI distress and digoxin is a sign of drug toxicity.

1:17:35 So it looks like a lot of people if you got that that's good.

1:17:38 Now let me talk about some of the other answers.

1:17:41 I keep all my medications in a separate container.

1:17:43 That's good. Yeah. Good for you.

1:17:45 That's a good deal. Um, see? Well, I don't want someone's arthritis pain to be severe.

1:17:53 No one does. But here's the deal on NCLEX questions.

1:17:56 That doesn't have anything to do with digoxin, right? That is all about keeping a patient safe.

1:18:03 So would I intervene with C.

1:18:05 I would, but I can only pick one answer.

1:18:07 And that's all I got. I'm going to go with the nausea because that's likely a sign of toxicity. And we need to draw a level for them.

1:18:15 Now here we go. Are you ready? Just hold on. Buckle up.

1:18:19 We're going to go through a lot of these 62nd overviews.

1:18:22 Remember statin drugs are used to lower cholesterol but they can be really hard on the liver. Anytime your liver is not doing well, you can feel really tired.

1:18:31 Chest pain treatment for chest pain.

1:18:33 Nitro one every five minutes.

1:18:35 Up to three. Now. Morphine, oxygen, Nitroglycerin and aspirin.

1:18:39 People are still teaching a lot of Moana, but keep in mind, we're trying not to give the oxygen unless they really need it.

1:18:46 Long term treatment, we can use beta blockers, calcium channel blockers, and nitroglycerin. So statins and chest pain.

1:18:52 We've talked about the medications that you can use for those.

1:18:55 What about thrombolytics. Oh here's a 62nd view.

1:18:58 This is a killer deal because thrombolytics are clot.

1:19:02 They're clot busters. So this is a high risk for a patient.

1:19:06 We cannot give this to a patient who's had surgery.

1:19:10 Um, they've had GI hemorrhage.

1:19:12 They have uncontrolled untreated hypertension.

1:19:15 Or they've had CPR because that's trauma, because this drug will rip through any clot.

1:19:21 It's not just specific to go through the clot in your heart or the clot that's in your brain. It will rip apart any clot.

1:19:27 So the problem here is the person could hemorrhage and have severe damage.

1:19:31 So thrombolytics right.

1:19:34 The biggest risk for them is for someone to hemorrhage.

1:19:36 Image. So we've got to give it within four hours.

1:19:39 That's the time frame, within four hours of when symptoms set on.

1:19:42 Because it's such a high risk, we don't want to put them at risk for drug if the tissue cannot come back. So after four hours, even if we can reestablish blood supply, the tissue is not going to be viable or very good for us. Ooh. Heparin hospital Coumadin community.

1:19:58 Remember, these two drugs have lab work that go with them.

1:20:03 Now. Also some other lab work.

1:20:05 And we cover that in our series.

1:20:06 But I want you to just be thinking about this one has a PTT and low molecular weight.

1:20:13 Doesn't have to have a lab, but it can.

1:20:17 There's some lab work that can be ordered for it.

1:20:19 Here's the deal with Coumadin.

1:20:22 You've got PT and INR.

1:20:23 So heparin has got a PTT.

1:20:26 Coumadin has a PT INR.

1:20:28 And if a patient's going to go home on Coumadin.

1:20:30 Dietary question which kind of foods should they not eat if they're going to be on Coumadin. So which kind of foods should they not eat if they're going to be on Coumadin? Anybody? There you go.

1:20:43 Vitamin K rich foods. Green.

1:20:45 Dark green. Leafy. Yes.

1:20:47 You guys are sweet at that.

1:20:49 Good. Now. Thrombolytics.

1:20:51 Boom! They'll blow up a clot.

1:20:53 Heparin and Coumadin. Just stop new clots from forming and the ones that you have from getting bigger. That's the difference between those two modes of treatment.

1:21:03 Oh, I solutions. Okay, we got some pretty cool things coming up here. We're going to wrap up with IV solutions.

1:21:10 So you're ready. Hang on.

1:21:11 This is really super easy I promise.

1:21:14 Fluids can be two places in your body.

1:21:17 Two places in your body.

1:21:19 They can be in the cell or outside of the cell.

1:21:22 Got it. When they're outside of the cell, they're interstitial or intravascular.

1:21:27 This is important to know. And if this feels too fast for you, remember we've got other resources for you that you can watch it in a little bit slower.

1:21:35 So you've got three types of solutions.

1:21:38 Isotonic. Hypertonic. Hypertonic.

1:21:41 This talks about the types of patients you should give it with.

1:21:44 Remember when we call solution ISO that means it's an equal osmolarity to blood.

1:21:49 If it's hypoxic it's a lower tonicity than blood.

1:21:54 And hypertonic is a higher tonicity.

1:21:57 So osmolality osmolarity that's what we're talking about.

1:22:00 Here is a list of these.

1:22:02 And Alicia I think would be great if we send this slide out in our email to them.

1:22:07 So everybody has a copy of that.

1:22:09 Because that's just a quick way to remember what these are most important points.

1:22:14 Isotonic should not cause a major fluid volume shift.

1:22:18 Hypertonic is going to cause fluid to be dumped into your veins and vessels.

1:22:25 Hypertonic is going to cause fluid to go in the cell.

1:22:29 So hypo goes into the cell.

1:22:31 Sell. Iso should not have fluid go anywhere.

1:22:34 Hypertonic is going to be a challenge, right? That's when you're going to have more concentrated in the bloodstream. Fluid flows out I'm doing that super fast I know you need more information on this.

1:22:44 We'll send you this slide.

1:22:46 But also you can check it out I think we have some of that on our YouTube too.

1:22:50 So the isotonic solutions are isotonic because of this.

1:22:54 I'll tell you what we're going to do. We have five minutes left. So I'm going to send you guys if you will. Um yeah I'm going to send this to you guys and I'll give you a quick rundown on this one so that you have all these things.

1:23:06 Look at all this. We're going to have all this available to you because I don't want you to be stressed. So we will give you these, um, saline slots, saline slides, these IV solution slides because I want you to have it. And I will also give you a voice, a voice walk through on it, an audio file with it, and I'll see if I can post it on discord, because I really, I really need to hang out with some people on discord because I am.

1:23:30 I love hanging out with you guys.

1:23:32 So you can see we'll bring these back to you and I'll explain it where you have time to absorb it in your brain because you are.

1:23:37 So you guys were just amazing today.

1:23:40 Great rock stars. So don't forget these will come back to you, Alicia, if you can forward it and show them the discord.

1:23:47 Um, subject again, the the link that they can go to as we are saying goodbye, I'm going to advance through some other slides so you can see the answers to this question. This one is that you would be most worried about half normal saline.

1:24:01 And why? Because the blood pressure is already low, and we're going to be walking through test questions too. But remember on this one here's strategies you can take to any test question.

1:24:11 Know where you are. You're in the air. What happened.

1:24:14 Abdominal trauma. What am I worried about with abdominal trauma hemorrhage heart rate that's higher than normal.

1:24:20 Blood pressure. That's lower than normal.

1:24:23 What does that tell me right away? Heart rate. That's low blood pressure.

1:24:28 I mean, heart rate. That's high.

1:24:29 Blood pressure. That's low.

1:24:31 That means I am worried about hypovolemic shock.

1:24:36 So the reason I would question A.

1:24:38 Is because that is a hypertonic solution.

1:24:41 If I hung that, then all the fluid would shift into the cells out of the intravascular spaces and their blood pressure would drop even lower.

1:24:52 So that's why. Not a good idea right? Hypertonic solution will cause fluid to go into the cell and that will cause blood pressure to drop. Isotonic solutions shouldn't cause a major change in the fluid volume. It should stay right in the vessels.

1:25:11 Unless they're septic or something's going like that. But should stay right in the vessels. Saline is isotonic.

1:25:17 Lactated Ringer's is isotonic.

1:25:20 And we consider red blood cells.

1:25:22 Of course it's isotonic because it's actually blood.

1:25:25 That's right there. Okay.