Memorizing Pharmacology Podcast: Prefixes, Suffixes, and Side Effects for Pharmacy and Nursing Pharmacology by Body System

Beta Blocker Generations Mnemonic PRO BAM CARLAB

In this episode, I go over how you can use PRO BAM CARLAB to remember the beta blocker generations and what that means for pharmacology indications and adverse effects.

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and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Get a hold of my book, Memorizing Pharmacology Mnemonics HERE

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Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash moving. Let's get started with the show.

In this episode, I'm going to go over beta blocker generations mnemonic Pro bam car lab and I'll explain what I mean there. So before we start with the stems, let's just make sure that you've heard this that the all at the end of a beta blocker which indicates it's a beta blocker. There are some exceptions to that but it's two B's backward so it's Propranolol but if you connect the O and the L it should look like two backward B's and the stems are a little bit different but also cause a problem.

The first generation stem a law is the same as the second generation stem a law o-l-o-l and that causes a problem because Propranolol has beta 1 and beta 2 blocking activity and then second generation has beta one with bisoprolol Atenolol metoprolol so that's why you kind of need the mnemonic to separate like okay which is first generation the pro and think of primary it's your first grade and then bam b-a-m for your second generation.

Then I put Car Lab just to give you two of the third generation ones these guys are very clever in their stems and they kind of fixed the all problem if you want to call it that so these third Generations will vasodilate and you see d-i-l-o-l in Corvette de la and you see a for Alpha Blocker in La Bay to law so that little change the dill and the a for Alpha blocking helps you know okay well these are third generation at least I get these guys but I still need to be able to tell the difference between first and second generation.

Okay so when we kind of go to the next thing, the indications and giant schf hypertension really when we're going to the generations we're going to almost avoid problems as much as they are indications. So when you look at Propranolol when they first came out I mean this came out so long ago many of the patients were like my migraines are gone it's like oh well let's just try to use it for that and Propranolol is really good at helping prevent migraines in the first place.

The issue is though because that beta 2 blocking activity we have these second generation bisoprolol Atenolol metoprolol which avoid the asthmatic issue of beta 2 blockade in general but then we want something that might print vent reflex tachycardia so if you can think of Carvedilol and labetalol as alpha blockers with beta blocking activity so that when you vasodilate which is a problem with the alpha blockers like prazasin you can prevent that reflex tachycardia because you are suppressing beta 1 receptors.

So again, Propranolol is the beta 1 and beta 2 blocker, bisoprolol, Atenolol, metoprolol these are the beta one only, and then Carvedilol labetalol these are the beta one beta 2 and Alpha One blockers.

Adverse effects tend to come from the mechanism of action so bradycardia can be a problem so if you get the heart rate below 60 and really a contraindication when you don't really want somebody to go that low bronchospasm specifically with that Propranolol where you are battling that beta 2 receptor fatigue is really a big deal because think about it you go on a run and your heart rate increases but you're taking a medicine that won't let your heart rate increase so you're going to get fatigued.

A heart block if you use too much of it and then reflex tachycardia can come from stopping it abruptly so imagine that you're kind of pushing down on a spring and then all of a sudden you let your hand go well that's kind of what you're doing if you take away a beta blocker very quickly.

The considerations kind of come from the adverse effects so you want to be considerate of somebody who has asthma or COPD because if we're using a beta blocker how do we choose the right one well if they've got asthma then we're not going to choose that first generation somebody's bradycardia certainly we don't want to suppress their reduce their blood pressure too low.

This one's a big one, mask the signs and symptoms of hypoglycemia. So normally someone who's hypoglycemic is going to get kind of very jittery palpitations but with a beta blocker they may not feel that at all and go into a hypoglycemic State and it might be masked or covered up.

So again, hopefully that quick review of beta blockade and the generations kind of puts it together really quickly and if you need my help Tony the pharmacist gmail.com. This information is provided for informational purposes only this is not medical advice if you have a medical question contact a medical professional.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes, cheat sheets, and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash Melbourne. Thanks again for listening.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

PRAZOSIN Alpha Blocker Mnemonic (Prazosin, Doxazosin, Terazosin, Tamsulosin, Alfuzosin)

In this episode, I go over how you can use PRAZOSIN to remember many of its indications.

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Get a hold of my book, Memorizing Pharmacology Mnemonics HERE

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Alright, welcome to Memorizing Pharmacology podcast. Today I'm going to go over the prazasan alpha blocker mnemonic and talk a little bit about stems and indications and all that stuff. So first thing you need to know when you're looking at an alpha blocker it's probably going to end in a Z O S I N. I'll talk about some other ones that end in O-S-I-N and how those are a little bit different but prazasin doxazosin terrazasin some people pronounce it doxazosin terazocin you know tomato tomato but these are three of the big ones that you'll see when we're talking about alpha blockers.

So the big thing is to take prazis in the word and look at the indication so the PR and prazasin for prostate helps with BPH or benign prostatic hyperplasia take the Raz Raz in prazasin for the ray nods and I know it's spelled with an S but it's actually sounded out like a z so R A Z and then the IN at the end for hypertension.

So again those can help you remember the kind of three main reasons why you would want to use an alpha blocker president has fallen out of favor because of the side effects but I'll talk a little bit more about that in a minute.

So how does it work? So mechanism of action is Alpha blockade so we relax the bladder neck so the prostate vasodilation is how it helps with Ray nods and Ray nods if you don't know what that is it's fingers and toes kind of get really cold because I have some vasoconstriction so a little bit of vasodilation hopefully warms the fingers and toes up and then vasodilation again helps with that hypertension.

Okay, but the adverse effects also come from that vasodilation so reflex tachycardia your body's not happy that the blood pressure is going down because your blood vessels are opening so your heart rate will go up orthostatic hypotension is that when you stand up it your blood pressure goes down and this often results in something called first dose syncope or first dose fainting or first dose phenomenon there's many different words for it but on the first dose your body is just not ready for this and you faint or you drop.

And so we'll talk about what to do about that so in terms of contraindications really kidney and circulatory disease is is really the big one where we can't really use the alpha blockers but in terms of that first dose syncope or the orthostatic hypotension if you give it right at bedtime when somebody's going into bed it's not a big deal you're not going to fall down out of your bed and then gradually sitting to stand that's a big one with these sometimes oh you really have to be careful with it.

But then you know intuitively would think okay well if you've got elderly patients we really probably wouldn't want to use an alpha blocker uh but let's talk about those more specific alpha blockers tamsulosin and alphuzosin uh Flomax and your oxitrol because these really don't have those adverse effects of you know as much as uh prasacindox as a centracin these are really favored for BPH patients are much happier with these medications.

And so they've gained tremendous popularity in terms of what they're for it makes it pretty clear with the Flomax and your oxitrol you know so allowing you to have more maximum flow as it relaxes the bladder neck or urine control you know kind of something like that I.

And what I do want to mention though is that you know when you're when you're using those alpha blockers you're helping with BPH in the short term so patient enjoys quotation fingers enjoys enjoy some relief from their condition in the beginning but you haven't fixed it to fix it you actually have to reduce the size of the prostate.

And those are the five Alpha reductase Inhibitors finasteride prostate care pro scar is the brand name it also helps with hair loss so that's why they call it Propecia the opposite of alopecia and then do testeride which is avidart these actually reduce the prostate size but these can take six to 12 months for maximum effect.

So that's why you have the alpha blockers in the short term and then these will be added and then these help in the long term. So again a disclaimer this is just for informational purposes only it's not medical advice if you have a medical condition consult a medical professional.

So thanks again for listening to the Memorizing Pharmacology podcast. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening!

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Chemo Man 5-Minute Mnemonic for Cancer Medications

This video goes through an easier way to memorize chemotherapy's adverse effects of some of the more common drug classes with what is best known as chemo man or antineoplastic man.

You can find the PDF version of the content here: https://residency.teachable.com/courses

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Hey, welcome to Memorizing Pharmacology podcast. I just wanted to go over the chemo mnemonic and sometimes it's relatively easy to say okay I get it but what we want to do is make sure that we do get it because there's an alphabetical way that's a little bit easier to remember all of it.

So the first thing is that we're just going to use these letters A B C D E F then then M N O P then T U V but we're not going to use the vowels so we're only going to use A B C D F M N O N P T and V okay and so it's going to look like this.

So Chemo Man or Antineoplastic Man is meant to help you recognize the adverse effects that go along with certain medications. So B for Bleomycin and B sulfin, C for CIS platinum and carboplatin, D for doxorubicin, F for Phi Flora uracil, M for Methotrexate and for the nitrosurias like the mistine cremastin cyclophosphamide we're actually using the P in the middle of the word because we've already used a C.

The taxines T pacletaxyl dosataxal and then the vinca alkaloids Vin Christine van blasting and because it's a little bit hard to remember 10 things at a time we're going to go five at a time so we're just going to make two smaller chemomans and then we'll combine it all at the very end.

So again B for bleomycin and abusolfin pulmonary fibrosis, C for cisplatin and carbo platin ototoxicity with the ears nephrotoxicity with the kidneys, doxorubicin is cardio toxicity right here in the Middle where the heart is in red. Five Flora uracil is Milo suppression we put that around the knees and the legs as well as the Methotrexate also myelo suppression.

Then we get to the Nitro Series so we have that neurotoxicity we put that on top of the head the mustian and carmiston cyclophosphamide is the P in the middle hemorrhagic cystitis we put it right here. The toxins are going to be paclitaxial and dose taxol that's peripheral neuropathy. The T and same with the vinca alkaloids, the V peripheral neuropathy.

I think it's a little bit easier to read this one but I did make one that had all of the colors match up so blue with the ones that were blue and green were the ones that were green red for doxorubicin if you want to look at that one too.

And what I did was I actually made a PDF of this so if you want to get the PDF you can go to residency.teachable.com and you can find this if you want the download as well.

So again if you need my help Tony the pharmacist at gmail.com otherwise I will see you in a next episode. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening thank you.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Vaccine Schedule Mnemonic in 4 Minutes

You can find the PDF version of the content here: https://residency.teachable.com/courses

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Here is a Vaccine Schedule Mnemonic that you can learn pretty quickly that I made using Excel but that you could easily do on a Google doc as well.

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Hey, welcome to Memorizing Pharmacology podcast. I just wanted to go over a quick mnemonic set for you for the vaccination schedule. So we're going to start with birth B for Hep B and the mnemonics are up at the top and the actual vaccines are down at the bottom. Then we want to be Dr. Hip at two months okay that's Hep B, DTaP, rotavirus, hemophilus influenza inactivated polio virus vaccine and pneumococcal conjugate vaccine.

And then at four months we're just Dr. Hip no B for Hep B so DTaP, rotavirus, Hib, IPV, PCV. Then six months we want to be Dr. Hip again and that I N from again is for the influenza virus that we're going to start that vaccine at six months.

Then 12 months I have an HP monitor view literally this is these are HP monitors or Hewlett Packard monitors so it goes from Hep B to Hep A then we're also going to still have our Hib our PCV and now we're going to add MMR and varicella so an HP monitor view at 12 months.

Then from 5 to 8 AM that's kind of dawn so we keep our DTaP and then from four to six years we have dusk so around four to six PM starts to get the Sun starts to go down a little bit tougher to see and so it's a bit dim so DIM for DTaP IPV and MMR and then view for varicella.

At 11 to 12 years we have Tdap and the important thing is that you kind of think of ta-da because which is how you would say it but the key is to get from DTaP to Tdap and know that 11 to 12 is when we make that change. Papilloma there's two L's in the middle that looks like an 11 and then meningococcal 12 is when you become an adult or men when you look at the back of for example a Motrin liquid you see that it only goes up to 11.

And so when you're talking about dosing something like that that's when you start using these adult doses and then it's 16 year old men get kind of a boost and that's the next booster for meningococcal.

And then there's some kind of goofy ones at 19 years with Tdap that's really if you're an adult you've never had tetanus before 19 and over you definitely want to do that and then in pregnancy to prevent whooping cough it reduces it by like 78 percent for someone that's under two months you're going to do 27 to 36 months now how do you remember that well the reason I put them together is that it makes up one two three here so 19 years for that adult 27 to 36 months for someone who's pregnant.

And then the 20 to seven to thirty six how do you remember that well it's two three going up and seven six going down. So hopefully that's helpful to see the vaccine schedule mnemonic in four minutes or less.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Free Pharmacology Textbook Pros and Cons

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

I use a combination of a free textbook and a supplemental textbook in my pharmacology courses, but you can check it out the audiobook supplement I use to the printed/e-textbook here https://www.audible.com/pd/Memorizing-Pharmacology-Audiobook/B09JVBHRXK?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Welcome to the presentation on pharmacology open educational resources. What I'm going to do is I'm going to go through a number of questions and talk about how open educational resources are good and where there's some actual negatives that come along with it. But certainly, the idea that we're trying to get less expensive materials to students is where we're going to start.

Question one: What prompted you to use OER with your students? So a big trend that has come around is the ability to rent a textbook. This is a book that I used to use, Lenny's Pharmacology for Nursing Care. It's very good, very well written, it's very comprehensive and you can rent it for thirty dollars for the semester which is great. I have a very reasonable price but you would have to pay probably about 110 dollars to own the book.

The issue with that is that when you are done with the course, you're not done with the need for the content. So although you'll have your notes and all of those things when it comes to taking the actual exam, the NCLEX, the nursing licensing exam, you don't have access to this book anymore and you would have to rent it again for thirty dollars.

So having a book that is available after you're done with the course is really what made it so that I could do this. So in a course and I'll show you that we use the OER for half the course and then some other textbooks for the other half of it but having a reference that you can still get to afterward that really was was the driving force.

So probably good that I show you the actual book. Okay so this is the actual book, Nursing Pharmacology, Wisconsin Technical College System. This is the book that you can use for free but that was a primary driver is making sure that now if you take this class and you have this book, you still get it. You can still retain it through that time.

And the big thing is when you go look and see how much is the Kindle? 83 dollars. That's relatively expensive for the students to pay for and although it's nice to have the paperback in terms of actually looking things up in a book that is about a million words long, it's just super nice to have that ability to use a find feature where something like a printed book would be okay well what chapter was it where did I see it? Very difficult to do.

How did you find the OER you were using? Question two: It's pretty straightforward. I just put in Pharmacology OER. There's really only one book that's of this quality that's available and it just popped up in the Wisconsin Technical System.

Question three: If using OER is using OER more work and if so why is it worth it? It is a little bit more work. It's certainly worth it to make it more accessible to the students but let me kind of go through why it's a little bit more work.

Let me show you how the book is set up and that'll make me make it a little bit easier. You can download it, get a PDF of it but I'm going to use it in this way because it's a little bit easier to get to everything.

So when we look at the contents and it's going to be here on the left hand nav bar, it's really well done. You've got one through ten so you've got all of these chapters. It's relatively comprehensive in terms of getting those things that you would need for nursing pharmacology course.

It's got an answer key to all of the critical thinking activities in there and there are quite a few of them but the big thing is that it's tough to present so let's go into kinetics and Dynamics okay so here's the first one and it's just okay this is what the learning objectives are and then you kind of go to the next one.

You know one and go into pharmacokinetics and so when you're presenting something like this, it's a textbook. You've got that but what you don't have are ancillaries. And so ancillaries are Powerpoints and explanatory videos and things like that those you will have as you go through it and you can kind of see.Here is the corrected version of your text:

"Um, you know, there's this moving graphic there. This is a little something for you. And then when you get to the learning activities here, which are generally in the back, you can see that there's kind of a matching. But the thing is, is that it's for lack of a better word, a little bit random in what it is. It's 14 cards about what was going on through the chapters and there were 11 modules in it. So you've got a little bit of vocabulary there and then these are really good.

The light bulb moments are case studies which are very useful and helpful as well. But generally in a publisher book, you would have a significant number of these and you would have the rationales and here you only have the answers. So although you do have the answers at the end, it doesn't really tell you why it's the answer in tremendous detail. So although I think that the interactive activities and the critical thinking are great, the publisher is generally a bit better when it comes to giving Powerpoints and visuals and those types of things that you would need.

Oh, what do your students think of OER? Question four: Students are obviously happy to have a book that is available, accessible to them during the class and after the class and the fact that there's no cost to them is key. So students are very much in favor of OER and are really kind of coming to expect that it's going to be included as we're kind of moving forward here.

Yeah, so as I mentioned before, the one big benefit that they don't see with commercial textbooks is that they can retain the book afterward especially when it comes to a digital copy. So you saw that book although you could rent it for thirty dollars, the physical book, the actual Kindle book would have been about ninety dollars. So relatively expensive. So keeping that book for their licensing exam, that's really the big benefit.

Okay question six: Does the OER allow you to update or change content if needed? I'm not aware of being able to change the content but the bigger issue is that there's no point person. So with a publisher I can contact the publisher and say hey you know this is what I would really want in the book maybe you have a different book that does this but there's really no one that I can talk to.

I know that it was done through a grant and there's a project but not only can I not update it but I'm catching errors from time to time. I don't know who to tell and that's kind of a bit of a concern. So while my students I can clear the error let them know that it's there I can't actually remove it from the document and that's a concern.

Question seven: What happens if a student needs to have a print copy of the OER? That's actually relatively straightforward. That is available to them and I'll show you the breadcrumb trail here. So while you need a printed copy if you wanted to print it you could print the whole PDF and all the pages but um you can and you have to do a little digging you can go to Amazon and find it here.

It's a little bit misleading in that it's a different color cover which makes it a Little bit difficult but OpenRN is the author and then you can find the book is the same. So there are a couple of copies of it, it looks like. But again, it's not the easiest thing to find. So most are fine with the eBook but those that want to print book you can get it. But I'm not sure if this is print on demand where you know, are there really only four available or is this something that would just print as students want it. Alright, let's move on to question eight which is what's been the hardest part of using an OER.

And I think that that really comes down to where does it fit into the course and how many credits of book is it? So this takes some digging and this is where you really want to kind of get a little backstory on it and figure out who's using it in what course. And so when we go to Chippewa Valley Technical College, we go to their course search and we go down and we find Nursing Pharmacology. This is course 543-103 and this is the real issue. It's only a two credit class so that means that this book was written for a two credit class when nursing schools have courses that are from three credits to six credits.

Now that Pharmacology for Nursing Care, that's a million word book. It can be used for any course like that but now we're in a position where here DMACC, it's a four credit class so I only have two credits of book in Nursing Pharmacology. So the question is how do I fill in the other half of it? And that's where we have to go to a traditional book and what we do is use a general pharmacology book that's going to fill in more details of a lot of the concepts and then also have the ancillaries make it a little bit easier.

But that's really the toughest thing is that when you have a book that does not cover all the credits, you have to marry that with some other content. But again, it's most important that you go to a course, find where they use it because you don't really have a word count in the same way that you could just look at a physical book and say okay I know how much detail this is in. That Loney book has over a hundred chapters where this nursing pharmacology book has 10.

And although the chapters are very specific, as you get into a pathophysiologic class like gastrointestinal, there are other chapters. So let's kind of look at the book itself when you go back and you see okay here's the book and you say it looks like there are only 10 chapters but the way Lenny does it, it actually makes each of these individual pieces into a chapter.

So when you look at the number of chapters, you would say well this one actually if you count the content chapters, you're looking at 11 chapters in kinetics another six chapters in legal ethical antimicrobial would then have quite a few actually it goes down to 21.

So really figuring out without a physical book and it's a lot easier to do this with a physical book that you can put them side by side and say okay if this is two credits then what is three credits or what is four credits? So I think that's one of the toughest things is making sure that you are satisfying the rigor of the course in terms of how much book you need.

Question nine: What advice would you give a colleague who is considering OER? OER is a lot easier for a class that you teach over and over again so we offer pharmacology fall spring summer so it's very easy to say okay well this is a course I'm going to be teaching year round and it would be nice to know who else is doing this.

The big thing is that if you're, I feel like a lot of us are reinventing the wheel and we're starting from the beginning because we don't really have a connection to it. So it would be nice if on the website somewhere we could just say hey I'm using it, this is my contact information so if you're using it great, you know I'd love to get your information kind of see what you've done with it. And I'll talk a little bit about one thing that I have done which is create a podcast with the critical thinking activities and talking through them giving them a lot more detail fixing errors and things like that.

But the big thing is if you're going to do OER, make sure it starts with a course that you're going to be teaching significantly fall, spring or multiple times because there will be an investment of time which is certainly worth it but that would definitely be the first step.

Question 10: What is the one thing you know now that you wish you have known would have known before you got started with OER? I think really the importance of ancillaries. There's an expectation that an instructor is going to give their PowerPoints to the students and not having those PowerPoints is just a kind of a very difficult thing in terms of a starting point.

So I think it would have been good to get to a point where there would be like kind of a building semester where I could really think about okay well what are the key pieces here that we would want to use. And I found that rather than creating PowerPoints, I created podcasts and that was a really good place to go and they've evolved as I started doing them.

But part of the course has pathophysiology which is foundational for understanding pharmacology and some of the critical thinking activities are more pathophysiology than pharmacology. And so it's just a matter of going through the book and kind of getting those pieces together as something that would be something a student would want.

And I just know that podcasts especially video podcasts where they can see everything would certainly be something that they would buy into. And here's the podcast, you can see that it's getting quite a few ratings and there are a lot of students that are getting a lot out of it. They're all video OERs and although I just kind of started a little bit slow, I did kind of get through quite a few of them.

So I'm really extending the length of the time that you want to work on a project like this and having the okay I'm gonna do one small thing each time, kind of going with the I think it was BJ Fogg's book Tiny Habits to make it a very tiny thing which is okay I'm gonna do one activity "Whereas when I first started, these I did like all the activities for the chapter and then I found that students really prefer that you like okay well I want to go back to just something very small. And so some of these are tiny so the antiarrhythmic mnemonic so you can go through the five classifications of the antiarrhythmics that's seven minutes, it's not very long at all. And then the cardiac interactive also not very long so I put that in there as well and then just a single case study for congestive heart failure took about 17 minutes.

So they can be extensive and really you want to think about drive time when you're thinking about podcasts so 15 to 20 minutes at most. So that if they do have a long community that's fine, they can listen to multiple episodes but when you're talking about how long you know it should be if you're putting the class upside down where you want them to listen to something and watch something first then you really want to keep to under that 20 minutes.

So GI pharmacology there were a number of case studies there as well and having it on a podcast makes it a little bit easier. It's free to everybody kind of sticking with the Creative Commons license and all that. So Memorizing Pharmacology podcast, I started it with some things that I had done and kind of went into this OER to try to get through the book. A little behind with the episodes, last one was just after Christmas so hopefully I'll be able to get the next chapter in.

But again these podcasts have been well received and it's just kind of being able to use the material and to make it your own. But again when you talk about the amount of time it takes to do something like this, I'm really thinking about okay can I do this in a year rather than can I try to get this done for this semester is really a much better timeline in terms of how to do this.

Okay question 11: Will you continue using OER and if so why? So certainly for this course, I've put a lot of time into it and I feel confident in the book though again each year that book gets more and more dated and that's a real issue. So who's going to update it? Is somebody going to update it? When are they going to update it? I don't really even know who to ask.

But the other thing is that because I've used OER in farm now we use OER in chem and we're finding that when you look at what the publisher is doing and what we would prefer from the publisher those interactive activities and those platforms we allow the publisher to do that part of it. And then for us what we really want is okay is there a book that's OER and there's a couple in chemistry.

So not only am I continuing to use OER in this now introductory chemistry, I'm able to use OER for the students as an alternative to a very expensive print book but we do use the Publishers ancillaries.

So in terms of kind of a conclusion to all of this, I think OER does a good job of getting the textbook out there but when it comes to the ancillaries those types of things that are really engaging and allow the students to do really kind of neat things PowerPoints all those things those tend to be things that a publisher may do quite a bit better.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening thank you.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Video OER - GI Pharmacology Case Studies

In this episode, we go into the pharmacology of the Gastrointestinal (GI) system and some relevant case studies. You can find all the GI episodes here at https://www.memorizingpharm.com/oer

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of The Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show. Hey, welcome to the Memorizing Pharmacology podcast. We're going to be talking about GI case studies today in Pharmacology. I'm Tony Gary, your host, and let's just get started.

So, we're gonna actually go all the way to 7.3 which is our critical thinking activity. A patient who underwent surgery recently has a medication order for daily pantoprazole. The nurse reviews the patient's medical history and finds no history of GERD or peptic ulcer disease. The patient does not report any symptoms of heartburn, stomach pain, or sour stomach. The nurse reviews The Physician orders for an indication for this medication before calling the provider to clarify what is the likely indication for this drug therapy for this patient.

So let's start there okay so this is an excerpt from Memorizing Pharmacology Relaxed Approach second edition and we see pantoprazole is here with the brand name Protonix. Many students will only memorize the generic names because that's all that's going to be required on for example the NCLEX but it actually makes there's two reasons to memorize brand names one it's easier to know what it's for and two if you've ever tried to remember somebody's name and you try to remember their first and last name it's always easier.

So when I'm taking role for the class and you know we class start classes again here in January I'm going to always put the first and last name and I'm going to take the time to learn their first and last name and although I'll probably only address them by their first name it just is so much easier for me to remember their name with the first and last.

So here we are in pantoprazole Protonix we see that prezol is the ending and that's for a proton pump inhibitor something that makes it so that we have less acid in the stomach and the brand name is protonic so it mixes protons that's where the name came from where it gets rid of protons and pantoprazole like esomeprazole or beprazole comes in an IV form but the most important thing is that now we know what it does but we're not necessarily sure why it's there for this particular patient.

So we know it stops proton pumps and that it reduces acid so let's go back to that case and the patient has no symptoms they don't have heartburn they don't have stomach pain they don't have sour stomach why in the world are there are they on you know this medication well the key is actually here they underwent surgery and because they underwent surgery there's a stress response where they might get a stress ulcer and by suppressing that HCL or hydrochloric acid that's why we're using it we're trying to avoid stress ulcers.

Alright let's go on to the next one anti-diarrheal medication a number critical thinking activity 7.4 a a patient has been prescribed loperamide for diarrhea associated with gastroenteritis patients begins to complain of heart palpitation what is the nurse's best response and then we'll talk about two what child Aid 6 has diarrhea the mother asked the nurse what OTC medications she can provide her child to help resolve the diarrhea what's the nurse's best response.

So let's go back to the book again and we'll go to the anti-diarrheals here and we see loperamide and the brand name is imodium so loperamide doesn't have an ending or a stem that's going to be useful it's in a mide but that's just a chemistry term that's not really going to help us but what you can do is you look at loperamide and you see low Lo and then per which is the first part of peristalsis Is a way to think of an anti-diarrheal that will slow down peristalsis and will help prevent diarrhea. Also, Imodium is like the word immobile and it is really immobilizing the bow for a little while to prevent that diarrhea as well. So two mnemonics there to help you remember it. So we go back to the question here and what is the deal with the heart palpitations? We know that the patient is taking something for diarrhea. It's meant for cons it's meant to actually create a more constipating effect but now we know what to do now we know what to look for and there is a black box warning on low paramide that an abnormal heart rhythm can happen so the nurse will do an assessment. I want to make sure we have understand heart rhythm and heart rate and then obviously contacting the provider is key to provide those results.

Now this age six child it kind of depends if the child is in you know having severe multiple diarrhea over the course of the day that's a very different thing where the patient might become very dehydrated and that's a real concern but if this is just a one-time thing maybe we're thinking about something like adding yogurt which is you know a good source of probiotics or something like that it just kind of really depends and the big thing I want you to take away is that diarrhea is not a disease it is simply a symptom and so if it is a symptom something else is probably going on if just the one-time thing no problem little yogurt that's fine but if it's happening more than once we really want to kind of think about contacting a provider.

Let's go to 7.4 B okay so this is our third of the four cases we'll do today. A patient went under underwent hip surgery two days ago I was not had a bowel movement since before admission. The patient is receiving Oxycontin ER 10 milligrams every 12 hours an oxycodone five milligrams every four hours for pain. Patient describes abnormal discomfort and the nurse finds decreased bowel sounds in all quadrants. Nurse notifies The Physician follows the bowel protocol and administers docusate sodium to the patient.

One, what are the potential causes of constipation that should be addressed for the patient? Two, what is the mechanism of action for docusate? Three, the patient asks how quickly the medication will work what is the nurse's best response? Four, what other preventative measures for constipation should the nurse teach the patient? And then if docusate is not effective within 24 hours what other medications can the nurse anticipate to be ordered?

Alright so we've got quite a bit to unpack here but let's let's kind of go back um so this is a bit of an error to put the not caps here to show that Oxycontin ER is a brand name and that's this is a long acting opiate and then oxycodone is a short-acting one for breakthrough pain so you've got a long-acting opiate and a short-acting one and that amount of opioids is certainly going to cause issues with constipation so we've kind of got what's going on um with that so the opiates for sure and there might be some side effects of anesthesia, the fact that they're not really moving around they're sedentary and that you know you're not really going to take a ton of I can drink a ton of water eat a lot of food um just after surgery so all of those things really kind of come together to necessitate this docusate so the potential causes of constipation that should be addressed you know the opiates are we using the lowest amount possible uh you know are we adding the docusate are they taking it on time and so forth how does the docusate work well it.

It really helps to go back to the mnemonics here and what docusate sodium you would want to think of docusate rhyming with penetrate because what it really does is help water penetrate the bowel and soften the stool. That's how it works and then you can also think of the brand name Colace that improves the Colon's pace. So again, I know that you don't have to have the brand name for many of your exams but makes it so much easier to know what this is for and also remember how to use it but going back to that question.

Docusate softens the stool and then that way we're going to get more bowel movements. This is a real disappointment for patients or how quickly does it work it can take half a day but it can also take up to three days and the patient will likely have been given this pretty quickly but they're going to be a bit uncomfortable for a while and they might be asking for something more rapid and it's tough to say well you know right now we're just going to kind of stick with this make sure we're drinking enough water making sure we're moving around and doing those things but this is the gentlest kind of best way to work with these constipation issues.

So the other preventative measures for constipation would include you know kind of increasing that fluid increasing the fiber moving around and again using the fewest opiates that you need to still provide pain relief for the patient. And then how do we know when to kind of go with docusate you know so if it doesn't work in a day well it can take up to three days but you can add something a little bit stronger maybe like bicycodile suppository or something like that which would only take only an hour or two or you could use an enema and those go 15 minutes but really you know a little bit of patience here is really good because you know some things really happened you really just kind of need to get moving around need to make sure you get the water in and then things can kind of get going again.

Last one 7.5 antiemetics so critical thinking activity 7.5 a nurse is caring for a patient who underwent surgery earlier today and is experiencing nausea and vomiting. The original post-op orders included Prochlorperazine but the patient continues to experience vomiting despite receiving this medication. Nurse calls the provider receives a new order for ondansetron orally dissolving tablets eight milligrams three times daily as needed. One, how will the nurse assess for symptoms of dehydration? Two, when administering the medication, the patients say this tastes terrible why can't I have a normal pill to swallow what's the nurse's best response? And then what other measures should the nurse teach the patient reduce the feelings of nausea and avoid dehydration?

Okay well let's take a minute to unpack this I'll take a minute and go back to memorizing pharmacology. The well this is the Kindle book but most people like the audiobook they've got the British narrators we'll start with prochloroperazine okay so Prochlorperazine is Compazine and it's a phenotizing that we used as an antiemetic um again it really is more about um you know making sure that the patient understands what the medications are for and what we're trying to do but ondansetron is that next step up.

And the on Dance Tron does have that ending, the Citron ending, and you may see ODT which doesn't taste bad because it's an orally disintegrating tablet and that's a choice that might make things a little bit easier for someone that's so sensitive to taste. It does affect neuro, the neurotransmitter serotonin which is located in the GI tract and it's kind of neat that in the word in dancetron if you're on dancetron if you're one of those people that likes word scrambles it's got every letter but the letter I from serotonin which might have been how they named it.

So going back to the question so now we know these are two antiemetics kind of doing a stepwise process here uh. The first thing we would do in making sure that the patient is not dehydrated, you know we want to check what they're you know to make sure they're not hypotensive make sure their heart rate is not tachycardic uh make sure that they do have you know a good urine output um and then check the skin for tenting uh and then you know checking the mucous membranes for dryness any or all of those can kind of let us know okay where are we looking in terms of dehydration.

In terms of uh, you know, the taste terrible if they have a tablet that dissolves um, The ODT that makes it a lot easier for the patient and it really does dissolve super quickly and then what? Other measures to reduce feelings of nausea and avoid dehydration sometimes include giving the medication before a meal, which may not cause as much of an issue with the nausea. Depending on the diet, if you're a little bit more on the bland side rather than the take-out spicy side, you're in much better shape. Again, more fluids will take care of the dehydration but that also might make them feel a little bit more nauseous. So the speed at which you rehydrate them, making sure that they're maybe taking sips rather than just downing something to get rehydrated.

Okay so let's go back just to the book itself and we'll kind of go here on Amazon just so you can kind of see. This second edition of Memorizing Pharmacology was meant to be more of a friendly textbook as it were. Most people don't get the paperback, most people get the Kindle because they like to be able to search. It's kind of nice when you're doing your homework, you're trying to find something and that one's I think 10 bucks but the audiobook if you've never had it before and you just kind of want to get better at pharmacology over the weekend or on the wave to and from school.

The way they work it is if you go to Audible or if you go to Amazon.com and I own it so it's not going to be up there but they'll let you have it for free and then make sure you know if you don't want to be part of that Audible thing you cancel within the first 30 days. But I found that a lot of my students when they make pharmacology part of their day morning and night because this is in a specific order starts with gastrointestinal musculoskeletal and so forth that if they kind of keep hearing it and that they don't have this kind of jerky I'm going to do some Farm on Tuesday some Farm on Friday or all farm on Sunday night that's what causes all of that anxiety.

By doing a little bit each day and just kind of embracing it I think it works well so a lot of people will say you know I'm not good at farm and what we really want to say is well I'm not really good at Farm yet. It's something I got from a chemistry professor here which I'll have an interview for you a little bit later but you're just not good at pharmacology yet and it takes some time to do that and it's really hard to do it if you're doing it once a week or twice a week and that you're not really kind of embracing it and listening to it each day and getting the rhythm of it.

Because what happens is that once you kind of get GI, you're still going to get a couple of other ones for example the musculoskeletal. You'll have talked a little bit about opioids opiates because you're going to have to talk about how to deal with the constipation and then when you get to the opiates like oh yeah yeah I remember when I was doing that GI chapter I remember the medications for the opiates and then now you kind of get into musculoskeletal and you think about okay well diazepam is one of those ones that affects muscles but isn't that used for isn't that used for seizures and stuff in neuro.

And as you're going through each chapter, it just makes it a little bit easier for you. So again, I did spend a lot of money on a British narrator because I get it pharmacology is not the most exciting for many people and by having that British narrator, it just kind of elevates it a little bit makes it more pleasant to get through.

So alright well that's it for this week. The GI pharmacology cases hopefully those are helpful for you and I will bring back a new pathophysiologic class next week. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com again. You can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile thanks again for listening.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Video OER - Pharmacology CHF Case Study

In this episode, we continue our dive into Cardiac System pharmacology. You can find all the cardiac episodes here at https://www.memorizingpharm.com/oer6

In this video, we go over a CHF Case Study to better understand the process of finding issues in the therapy and treatment of our patient

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show. Hey, welcome to Memorizing Pharmacology podcast. What we're going to do is do a case study nursing care of the adult heart failure patient in a long-term care setting LTC and what we want to do is maybe not take a shortcut as much as see maybe how a pharmacist can see it sometimes where they just look at the medication record and they're already looking at a couple of interactions that are common and of concern and they lead you to the answer without necessarily having to do all of this stuff with the case but we'll go through the whole thing just for the um activity itself. So what we're going to do is we're going to try to provide care for an adult patient long-term care with a history of heart failure. We're going to identify some common assessment findings and we're going to talk about some common interventions as we go forth. So here's the patient Hector Fernandez is a 62 year old male patient who has recently admitted to a long-term care center for frequent Falls. This video I'm not going to play because if YouTube hears the video or its AI hears the video it'll shut this one down but you can go to chapter 6 14 module learning activities and play the video but the big thing is that the patient didn't want the TED hose on there and then there's some other pieces that we'll kind of go through now. Alright so here are some questions that kind of came from it so what is the underlying pathophysiology behind heart failure? A is it the heart muscle fibers shorten resulting in decreased filling volume? B, the muscle fibers are overstretched or weakened resulting in a decreased force of contraction and injected volume? Three, the contractility of the heart increases or four, the heart muscle is increased force of contraction due to overloading of the ventricles? So when you're talking about heart failure you want to think about that word failure and the word failure is really talking about how it's failing to do its job and it's failing to do its job because those muscle fibers are stretched and weakened so you have a decreased force of contraction and ejected volume and the big thing is that if you're getting less volume you're getting less oxygen not only to the body but to the heart itself because the heart feeds itself through the coronary arteries so we'll check that and we see that oops I got a I didn't never push the button okay so here we go. The muscle fibers are stretched patient and heart failure has a reduced force of muscular contraction okay uh next question is what do you expect to find on your assessment when the nurse states the resident has two plus pitting edema? So is it that applied pressure leaves an indentation of three to four millimeters that rebounds in less than 15 seconds? Does applied pressure leave an indentation of five to six millimeters that takes up to 30 seconds to rebound? The patient has swelling around the nail beds? The residence pulses must be found with a Doppler? Okay so what we're really doing is what's the difference between two plus and three plus pitting edema so Here is the corrected version of your text: The two plus pitting edema would be when we apply the pressure leave an indentation of three to four millimeters that rebounds in less than 15 seconds. The five to six millimeters with 30 seconds, that would have been three plus pitting edema. As you recall, the reporting nurses described that Hector refused to allow her to apply his TED hose this morning. Okay, and then the purpose of the TED hose is to increase arterial blood return to the heart and so that's the thing that we really want to look at, is it arterial or venous blood? So if we think about how blood comes back to the heart, arterial blood is ejected out very high pressure system but when we talk about coming back it's that the veins with their valves are just not doing it. They're not able to, you know, the patient's not walking a ton and it's just really difficult for that blood to fight gravity and go back up. So the TED hose are really to increase the ability of venous blood to come back. So we would call this false. Okay, check it and yes, alright.Here is the corrected version of your text:

"And then based on the report that was received, what are the priority focused assessments that you would do with Hector? Well, would we do abdominal renal and neurological assessments? Would we assess H-E-E-N-T head eyes ears nose throat neurological and skin assessment? Or cardiac respiratory and renal? And so because we have a patient that does have that heart failure background, we would definitely check the cardiac respiratory and renal assessment. Okay, alright so let's proceed to the next slide.

Alright so again we've got kind of one of those uh videos I'm not going to play it but I'll play uh the answers to the next pieces okay uh Hector reports that his heart skips a beat based on the statement what do you expect to find in your assessment? Difficulty ascultating his heart tones? An irregular heartbeat? A bounding pulse or a regular heartbeat? Okay so the skips a beat would probably be that irregular heartbeat that's indicative of heart rate abnormality and so we would probably find some kind of abnormal heart rhythm as we palpate and ascultate.

We decided to take Hector's Vital Signs and note the following results: blood pressure 158 over 100, heart rate of 58, respiratory rate of 18, temperature 37.5 Celsius, oxygen saturation 95 percent and pain level of zero. Okay, which of the Vital sign results are priority concerned for this patient? So again we've got a cardiac patient history of congestive heart failure so we would expect that this would it be the temperature? The oxygen saturation? The blood pressure or the respiratory rate? Kind of gave it away but the blood pressure would probably be the most significant with this particular patient. Alright so we complete the respiratory exam and it's kind of cool here you can have a listen to uh would you say those were crackles diminished clear or wheezing okay I think we would go with crackles I was a little bit uh of sound in there it certainly wasn't clear but we didn't really hear wheezing in there I know it's a little bit hard to hear but you can play the video on the slide as well okay what do crackles indicate about Hector's condition? Does Hector have increased fluid in his lungs? Does he require IV antibiotics for his lung infection? Does he have pneumonia and does he have a cold? So those crackles are really just the difficulty of getting that air in with the fluid in the lungs alright then the last one after you hear the crackles in Hector's lungs which are following priority assessments will you perform will you assessmentation strength and motor responses will you assess respiratory rate oxygenation status edema current shortness of breath signs of circulation assess capillary refill heart tones and signs of skin breakdown assess for signs of numbness and tingling and petal pulses yeah respiratory rate oxygenation status edema shortage of breath signs of circulation that would be right okay all right proceed to the next okay you assess Hector's lower extremities and you have to see it to find the following and then how would you characterize Hector's edema would it be one plus two plus three plus four plus again there's a video so if you didn't see it unfortunately yet I can't um I can't really show you all right and we're gonna see up three plus pitting edema so uh it was pretty deep uh and uh didn't really hear anything about the time with it but again you kind of do your best with the picture all right based on the information collected in your assessment you determine Hector's condition is improved worsen or remains unchanged okay so because of what we've seen we'd probably say that this condition has indeed, worsened. Alright, having gathered your assessment information, you consult Hector's admitting orders. What order takes priority at this time? Is it the Digoxin 0.25 milligrams PO daily, the daily weight, the Furosemide 40 milligrams every 12 hours by mouth, or Aspirin 81 milligrams by mouth daily? And so what we want to do is we're going to look at the orders here and we see that we're admitted to a virtual Skilled Nursing Facility. CBC chem 7 and every three months administer O2 via nasal cannula to maintain pulse

oximetry 95 percent or greater. Notify MD if O2 sat is less than 90 with oxygen. Cardiac diet 2 gram sodium low cholesterol low fat weight on admission and weekly weights. Physical Therapy consult. Now here are the medications: Aspirin enteric coated 81 milligrams one tab by mouth every day, Digoxin 0.25 milligrams every day, Furosemide 40 milligrams PO every 12 hours, Metoprolol 12.

5 milligrams by mouth every day, Lisinopril 10 milligrams by mouth every day, Atorvastatin 40 milligrams by mouth every day, Acetaminophen 500 milligrams by mouth two tabs every four hours for pain or fever as needed, TED hose on while awake. Elevate legs three times daily. And what we see here are some kind of classics. If I had seen an issue with the patient and some kind of cough I would have immediately gone to Lisinopril. If I had seen a diabetic patient I would have worried about masking hypoglycemia. If I'd seen a patient with muscle pain I

would have gone to Rhabdomyolysis with Atorvastatin but I see Digoxin and Furosemide and immediately I'm thinking hypokalemia before I even kind of go through to the next piece so let's go back to the learning activity and let's say Furosemide 40 milligrams every 12 hours but let's figure out how how would I know that like how would I know what these medications are for so we've got Digoxin Furosemide Metoprolol Lisinopril Atorvastatin where would I you know look and what you want to look at here are

the endings the samide of Furosemide that's what lets you know that it's a loop diuretic the alol of Metoprolol and you had to memorize that it was second generation so this is a selective beta blocker the pril or Prill of Lisinopril and the vastatin of Atorvastatin and again you can find that sheet on the memorizing farm.

com webpage when you if you sign up for the email list I give you a big sheet like this and I'll show you how it looks um so we see the simide part of the loop diuretic and we see that um the all here in Metoprolol and that's a second generation beta selective and we see the Prill in an Ace inhibitor and then we see the well it's going to be down here the vastatin of an hmg-coa reductase inhibitor which is also Lipitor the Atorvastatin here and then I think the anti-platelet was the Aspirin and then the cardiac glycoside is Digoxin so

using those endings makes it a lot easier to kind of understand okay I know what I'm dealing with with the medications right away don't have to look anything up it just you just see the endings but again when you're reading medications you're probably going to want to read from right to left rather than left to right okay so going back to this I would say Furosemide that would be the big issue because a Furosemide is causing hypokalemia that's a big deal when we see Digoxin okay so we'll proceed to the

next uh we're going to look at the lab results okay and we see here and we'll make this a bit bigger that we have hemoglobin that is a little bit outside of range a little bit low we see hematocrit is a little bit low mean corpuscular volume 74.2 just a little bit low the red blood cells and then this is the CBC with differentials so we'll go down to the next part which is the chem 7 and then we see the bun a little bit high at 30.

creatinine a little bit high at 1.6 but our real concern here is this potassium 3.3 that is under the 3.5 to 5.3 ml equivalents per liter and so when we see hypokalemia it's probably caused by the loop diuretic and with Digoxin that's a real big concern okay so after reviewing Hector's laboratory results which is a priority concern the creatinine the potassium the glucose or the hemoglobin definitely say the potassium okay hypokalemia is what we're worried about okay uh based on the laboratory results you

should notify the provider sure thing yep so what we're looking at is what would have the greatest effect on the potassium and heart rate okay and that would be the Furosemide Digoxin and Metoprolol okay so the abnormal potassium level and heart rate require that Administration and modification at this time okay you gather information to phone to Hector's provider regarding his current status what information would be a priority to report okay so would it be the current appetite and last bowel movement oxygen level and Pressure hemoglobin level and increased fatigue or the presence of crackles increased edema potassium level and heart rate. I think by now we've kind of got that this is a cardiac deal so presence of crackles increasing edema potassium level and heart rate this is worsening heart failure okay so this is just asking how you think the scenario went and then opportunity to give feedback so the big thing I kind of wanted to to kind of come back to was if you knew the stems you knew the digoxin was a cardiac glycoside aspirin was a blood thinner.

Furosemide was Loop diuretic metoprolol beta blocker second generation lysinopril ACE inhibitor and atorvastatin lipid or hmg-coa reductase inhibitor and the big thing is that if you know those it makes it so much easier and that's kind of where this whole memorizing pharmacology comes from. I understand many of your professors are going to tell you not to memorize things but what we're really saying is there are things you need to memorize as a foundation just like you have to know the alphabet to succeed in in vocabulary.

Or you have no medical terminology really to do super well in pathophysiology and Physiology and anatomy and what we're trying to memorize is what's the medication for and then as we kind of understand the systems then when we talk about side effects and therapeutic effects it really makes sense because you went through the whole process so when you understand heart failure and I guess I could have gone into you know what causes that hypokalemia when we get into the nephron and those types of things but maybe that's for a different lecture.

Foreign pharmacology podcast you can find episodes cheat sheets and more at memorizingfarm.com again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile thanks again for listening thank you.

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Video OER - Pharmacology Cardiac Interactive

In this video, we go over cardiac physiology to help lay the foundation for our case study in the next episode.

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and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

In this episode, we continue our dive into Cardiac System pharmacology. You can find all the cardiac episodes here at https://www.memorizingpharm.com/oer6

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology Podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Okay, welcome to the Memorizing Pharmacology Podcast. We're going to be doing another cardiac section here so we're going to have another interactive activity and we're going to just answer a couple of multiple choice questions again really understanding the anatomy is is key and to some extent the physiology to you know succeeding in Pharmacology so we're going to start with this question normal sinus rhythm is controlled by the and the easiest thing to do really in your head is to say well what order does this go in and the first thing is at the SA node then we go to the AV node then to the bundle of hiss and then the purkinje fibers so normal sinus rhythm though by the sinal atrial node the SA node and again the s in sa the S and sine is hopefully that helps you remember we can check to make sure it's right and we see that yep SA node is correct okay let's go on to question number two.

A severe, potentially life-threatening allergic reaction many of you would get it just from that one but I want to talk a little bit about the word and how sometimes being able to break down the word into its Latin and Greek can help you out. It can occur within seconds or minutes of exposure to something that you're allergic to such as peanuts or bee stings and some of you may have heard this is an allergic reaction or very severe allergic reaction but it has a word and it's anaphylaxis and if you look at the word phylaxis this p-h-y-l-a-x that comes from the word Phalanx so if you've ever seen the movie 300 where they put all the shields together that's a Phalanx and so an anaphylaxis is putting that Phalanx together to protect the body so what anaphylaxis is doing well it's this very scary closing of the airway and all of that it's actually meant to close off the airway to protect your body by shielding it from whatever's happening Anna just means again so it's really again guarding is is what it is okay all right let's move on to number three.

A bluish or purplish discoloration as of skin due to deficient oxygenation of the blood and so this is the key, the bluish skin, and it's a condition of so those of you that know medical terminology you're like blue okay what is blue in medical terminology okay that would be cyan and then what is a condition of that would be osis so you put together a condition of having blue and then that would be cyanosis process that the Oli level where blood is oxygenated and carbon dioxide, the waste product of cellular respiration, is removed from the body okay so what we're looking for is what's the word here that's going to help us out okay so blood is oxygenated and carbon dioxide, the waste product of cellular respiration, is removed.

And this is an exchange what we're basically doing is we're trading oxygen for carbon dioxide and so this would be a gas exchange. The oxygen is the first gas carbon dioxide is the second yep gas exchanges it. A deficiency of color especially of the face paleness, and that word paleness really gives it away because there's a word that's a synonym for paleness or this deficiency of color, and that is yeah pallor p-a-l-l-o-r so p-a-l and then we just had an l-o-r to make pallor all right.

An effect that is opposite to what is expected, an effect that is opposite to what is expected, and again we're using kind of our medical terminology kind of our Greek and Latin an effect that is opposite to what is expected, is going to be paradoxical. And when you break down para actually means contrary to, doxical is an opinion so it's contrary to popular opinion of what should happen so you have seen this word para especially where you talk about entero versus para enteral so or parenteral so you've seen enteral where you give a GI.

And then parenteral is actually outside of GI system or contrary GI system okay maybe we don't talk that way but whole idea breaking down these words understanding okay contrary opinion all right paradoxical effect but then we would want have example what paradoxical effect well something like diphenhydramine which Benadryl expect see some drowsiness paradoxical effect would excitement happens about third children take diphenhydramine really don't recommend any means young children so when you see paradoxical effect you can think of you know kid bouncing off walls because Benadryl doing opposite what was hoped which would make them drowsy instead it's not making them drowsy and taking care of their allergies but making them very excited okay number seven.

The total number of breaths or respiratory cycles that occur each minute okay so when we're talking about total number and we're talking about respiratory that would be respiratory and then per minute would be a respiratory rate okay a respiratory rate and then number eight okay so matter is expectorated from the respiratory system and especially the lungs that is composed of mucus but may contain pus blood fibrin and microorganisms such as bacteria and disease States so when we think of an expectorant we think okay what's an expectorant supposed to do what's it dealing with and that is dealing with sputum okay sputum.

So then we would think well what is an expectorant I'd say okay well when we're talking about Mucinex DM or dextromethorphan and we're talking about the other ingredient which is guaifenesin that would be the expectorant so sometimes we get confused between Mucinex DM which is expectorant guaifenesin and dextromethorphine antitussive or cough suppressant and Mucinex by itself which would just affect the sputum as an expectorant same thing with Robitussin and Robitussin DM Robitussin is just the expectorant and Robitussin DM includes the antitussive which is dextromethorphan so again check out if you're on the email list I've already sent you the PDF otherwise you can find it as an attachment on the memorizing Farm website okay well uh we'll go next time we're going to do a case study where we're going to look at someone who needs to use a peak flow meter to assess their level of asthma asthma and then we'll kind of move on from there from respiratory to our next section.

Thanks for listening to the Memorizing Pharmacology Podcast. You can find episodes cheat sheets and more at memorizingfarm.com again. You can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening!

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Pharmacology Antiarrhythmics Mnemonic

In this video, we go over a mnemonic to help you remember the five Vaugh-Williams classifications of antiarrhythmic medications.

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and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

In this chapter, we begin our dive into Cardiac System pharmacology. You can find all the respiratory episodes here at https://www.memorizingpharm.com/oer6

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology Podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Hey, welcome to the Memorizing Pharmacology Podcast. I'm excited to talk to you a little bit about the cardiac section. So what we're going to do is we're going to do an interactive activity with the antiarrhythmics and I think it gets a little bit confusing when we talk about them but we have class one which is the n a or sodium blockers and then we have well fast sodium channel blockers we have within that one a one B one C so procainamide uh lidocaine and phenytoin in one b and then flecanide in one C then we have the two which is the beta blockers but we can have you know the first gens which are like Propranolol second gen metoprolol and third gen Carvedilol uh we kind of moved down to class three which is amiodarone and then class four would be the Verapamil and deltaizum so the amiodarone is going to be a potassium blocking and then the calcium channel blockers are going to be the Verapamil and deltaism so one two three and four and then five we'll talk a little bit about adenosine uh in a second here.

Now what we're going to do is we're going to go over the antiarrhythmic agents or sometimes called the anti-disrhythmic agents and what we're going to do is we're going to just do a little matching here but what I want to give you is a bit of a mnemonic that can help you remember which class goes with which medication and the mnemonic is Nab K C A so NAB for sodium and a and the B for beta blocker and it may help if you do NAB and ABB that may help you even more and then k for potassium blocker or potassium channel blocker really and then C A for calcium channel blocker and then the last one is adenosine for five so this comes from the Vaughn Williams classification.

And you'll be told about the Roman numerals from a numeral one which looks like an i which is class one uh class two is two eyes class three is three eyes class four is an i with a V and class five is a v by itself so what we're going to be going over and I'm not going to answer these in the order that they're in I'm going to go class 1 Class 2 class 3 class 4 and then adenosine class five because what I want for you to do is to remember it using this mnemonic so class one what we're looking for is the word sodium or n a in one of the answers.

So here are the answer choices. And I know they're a little bit long but I just want to read them so that you can hear how kind of jumbled it is when you just try to read them without having any mnemonic or anything uh first one is medications prolonged repolarization by blocking the potassium channels in cardiac cells that are responsible for repolarization number two says anti-disrhythmic medications slow conduction and prolonged depolarization by decreasing sodium influx into cardiac cells medications increase the refractory period of the AV node by slowing the influx Flux Of calcium ions thus decreasing the ventricular response and decreasing the heart rate medications are beta blockers that are used to decrease conduction velocity automaticity and the refractory period of the cardiac conduction cycle.

And then a unique medication given to patients who are experiencing paroxysmal supraventricular tachycardia okay so our keywords were potassium sodium calcium beta blocker and then medication so now let's use our mnemonic our NAB K C A so the N A from NAB would be class one okay. And we saw that it was this answer anti-disrhythmic medication slow conduction and prolonged depolarization by decreasing sodium influx into cardiac cell so one is na in NAB class one Class 2 are beta blockers two B's okay so n a b b medications are beta blockers that are used to decrease conduction velocity automaticity.

And refractory period of cardiac conduction cycle class three was K so again it's NAB KCA so little bit tricky here because potassium when you look at periodic table it K calium it synonym potassium potassium comes from pot ash uh which where this comes from let's put that class 3 there medications prolonged repolarization by blocking potassium channels in cardiac cells responsible repolarization class four medications okay we're going match this increase refractory period AV node by slowing influx calcium ions RCA thus decreasing ventricular response decreasing heart rate but also use as class 5 which adenosine okay check okay see they're all right.

So again going from one we have our sodium which was our n a from periodic table again that's little bit tricky one also because it's natrium but we don't say that somebody is hyposodium emic we say that they are hyponatremic okay and then class two was our BB our beta blockers okay our class 3 was our k for calium which is potassium on periodic table class four was calcium RCA and then a for adenosine is our class 5 which really mechanism action kind question mark but so class one class two class three class four class five uh hopefully little bit easier way of remembering those uh from this cardiac module interactive activity.

Thanks for listening to the Memorizing Pharmacology Podcast. You can find episodes cheat sheets and more at memorizingfarm.com again. You can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Video Respiratory Pharmacology Vocabulary Flashcards and Cheat Sheet

In this chapter, we continue our deep dive into Respiratory System pharmacology with pharmacology vocabulary flashcards, answers, and rationales. You can find all the respiratory episodes here at https://www.memorizingpharm.com/oer5

Find the book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

You can find the self-paced pharmacology course here:

https://residency.teachable.com/p/mobile

You can take pharmacology with me here:

https://www.dmacc.edu/programs/pdp/pre-pharmacy/Pages/online-pharmacology-class.aspx

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com

Auto Generated Transcript:

Welcome to the Memorizing Pharmacology Podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Let's get started with the show.

Okay, welcome to the Memorizing Pharmacology Podcast. What we're going to do is some flash cards and if you are on the email list then you'll also get a one-page PDF of the notes and then you can quiz yourself on it. So if you want to get on the email list just go to that memorizingfarm.com. When the immune system reacts to a foreign substance and makes antibodies that identify a particular allergen as harmful even though it isn't, this is number one and what we want to do with a question like this is we want to take out the words that are most important so immune system foreign substance antibodies to an allergen isn't really harmful okay so something like that would be an allergy so again that allergen allergy very close together but that's what we want to watch out for and if you look at the word allergen and you think of the word generate that is to create something an allergen creates a response and then an allergy is the problem of having that response okay and we can double check and we see that yes that's correct okay let's go on to question number two.

A severe, potentially life-threatening allergic reaction many of you would get it just from that one but I want to talk a little bit about the word and how sometimes being able to break down the word into its Latin and Greek can help you out. It can occur within seconds or minutes of exposure to something that you're allergic to such as peanuts or bee stings and some of you may have heard this is an allergic reaction or very severe allergic reaction but it has a word and it's anaphylaxis and if you look at the word phylaxis this p-h-y-l-a-x that comes from the word Phalanx so if you've ever seen the movie 300 where they put all the shields together that's a Phalanx and so an anaphylaxis is putting that Phalanx together to protect the body so what anaphylaxis is doing well it's this very scary closing of the airway and all of that it's actually meant to close off the airway to protect your body by shielding it from whatever's happening Anna just means again so it's really again guarding is is what it is okay all right let's move on to number three.

A bluish or purplish discoloration as of skin due to deficient oxygenation of the blood and so this is the key the bluish skin and it's a condition of so those of you that know medical terminology you're like blue okay what is blue in medical terminology okay that would be cyan and then what is a condition of that would be osis so you put together a condition of having blue and then that would be cyanosis process that the Oli level where blood is oxygenated and carbon dioxide the waste product of cellular respiration is removed from the body okay so what we're looking for is what's the word here that's going to help us out okay so blood is oxygenated and carbon dioxide the waste product of cellular respiration is removed.

And this is an exchange what we're basically doing is we're trading oxygen for carbon dioxide and so this would be a gas exchange. The oxygen is the first gas carbon dioxide is the second yep gas exchanges it. A deficiency of color especially of the face paleness, and that word paleness really gives it away because there's a word that's a synonym for paleness or this deficiency of color, and that is yeah pallor p-a-l-l-o-r so the p-a-l and then we just had an l-o-r to make pallor all right.

An effect that is opposite to what is expected, an effect that is opposite to what is expected, and again we're using kind of our medical terminology kind of our Greek and Latin an effect that is opposite to what is expected, is going to be paradoxical. And when you break down para actually means contrary to, doxical is an opinion so it's contrary to popular opinion of what should happen so you have seen this word para especially where you talk about entero versus para enteral so or parenteral so you've seen enteral where you give a GI.

And then parenteral is actually outside of the GI system or contrary to GI system okay maybe we don't talk that way but whole idea is breaking down these words understanding okay contrary opinion all right paradoxical effect but then we would want have example what paradoxical effect well something like diphenhydramine which Benadryl expect see some drowsiness paradoxical effect would excitement happens about third children take diphenhydramine really don't recommend any means young children so when you see paradoxical effect you can think of you know that kid bouncing off walls because Benadryl doing opposite what was hoped which would make them drowsy instead it's not making them drowsy and taking care of their allergies but making them very excited okay number seven.

The total number of breaths or respiratory cycles that occur each minute okay so when we're talking about total number and we're talking about respiratory that would be respiratory and then per minute would be a respiratory rate okay a respiratory rate and then number eight okay so matter is expectorated from the respiratory system and especially the lungs that is composed of mucus but may contain pus blood fibrin and microorganisms such as bacteria and disease States so when we think of an expectorant we think okay what's an expectorant supposed to do what's it dealing with and that is dealing with sputum okay sputum.

So then we would think well what is an expectorant I'd say okay well when we're talking about Mucinex DM or dextromethorphan and we're talking about the other ingredient which is guaifenesin that would be the expectorant so sometimes we get confused between Mucinex DM which is expectorant guaifenesin and dextromethorphine antitussive or cough suppressant and Mucinex by itself which would just affect the sputum as an expectorant same thing with Robitussin and Robitussin DM Robitussin is just the expectorant and Robitussin DM includes the antitussive which is dextromethorphan so again check out if you're on the email list I've already sent you the PDF otherwise you can find it as an attachment on the memorizing Farm website okay well uh we'll go next time we're going to do a case study where we're going to look at someone who needs to use a peak flow meter to assess their level of asthma asthma and then we'll kind of move on from there from respiratory to our next section.

Thanks for listening to the Memorizing Pharmacology Podcast. You can find episodes cheat sheets and more at memorizingfarm.com again. You can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening!

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com