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

In this chapter, we continue our deep dive into Respiratory System pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer 

You can find the Memorizing Pharmacology book here: 

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

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

In this chapter, we take a deep dive into Respiratory System pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer 

You can find the Perils of Polypharmacy book here: 

https://www.audible.com/pd/B0BG98JWZ3/?source_code=AUDFPWS0223189MWU-BK-ACX0-323817&ref=acx_bty_BK_ACX0_323817_pd_us 

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

In this chapter, we take a deep dive into Autonomic Nervous System pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer 

You can find the book where I talk about prefixes and suffixes 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

In this chapter, we take a deep dive into Part 2 of antimicrobials in pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer 

You can find the book where I talk about prefixes and suffixes 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

In this chapter, we take a deep dive into Part 1 of antimicrobials in pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer 

You can find the book where I talk about prefixes and suffixes here: 

https://www.audible.com/pd/Memorizing-Pharmacology-Audiobook/B09JVBHRXK?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

OER Legal Ethical Pharmacology Cases and Critical Thinking Chapter 2

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

In this chapter, we take a deep dive into some of the legal and ethical issues surrounding pharmacology. You can find all the episodes here at https://www.memorizingpharm.com/oer

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

Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. We’re going to be starting the critical thinking activities in Chapter 2 of Nursing Pharmacology and what I wanted to do is show you where all of these videos and audio are going to be. So here is the Nursing Pharmacology book and what I’ve done is I’ve put it at memorizingfarm.com. And if you go to the front page, I know that this is a little bit small because this is what it would look like on a mobile and it’s just click here for the OER Nursing Textbook videos and audio which will take you to this page and here we have all of the links that you need to Memorizing Pharmacology, Memorizing Pharmacology Mnemonics and the Nursing Pharmacology Textbook and here are the kinetics and Dynamics. This is where you would find all of those videos so this Kinetics and Dynamics Chapter 1 button here will take you to the videos so we had video One video two and video three or part one part two and part three.

Alright, and the nice thing is that it’s not really hard to figure out where this is because it’s memorizingfarm.com OER one and then Chapter two will be OER2. And so eventually I’ll record the entire chapter readings again this will take some time so that will all be here for you so but right now we’re kind of going one chapter at a time and now we’re gonna hit Chapter two okay.

Alright, our first critical thinking activity is here at 2.2 a. I’ll read it to you and then I will give you a detailed response so critical thinking activity 2.2 a a nurse is preparing to administer medications to a patient while reviewing the chart the nurse notices two medications with similar mechanisms of action have been prescribed by two different providers what is the nurse’s best response well first I’m going to give you my answer and then I’ll show you another resource on the memorizing Farm web page that can really help you here.

So when you look at two similar medications with mechanisms of action for example maybe both of them reduce heart rate well we could make the patient bradycardic or both increase heart rate and they can tachycardic. And so the first thing is to clarify both with both providers that you know letting them know that we have this duplicate because they may not know that the other person is doing it and this is not uncommon for someone to go to their primary care physician I’d get a prescription and then go to maybe their cardiologist and get another prescription and only to find out that the cardiologist and primary care physician are not really communicating and that we have some kind of duplicate or something like that.

So I want to do is take you to Two web pages on the website. The first one is memorizingfarm.com forward slash drug hyphen prefixes hyphen and hyphen suffixes. This suffix and prefix list allows you to find a number of the medications and their suffixes. And these are the suffixes from Memorizing Pharmacology, The First Edition Just 200 medications. And for example, we can look in here and we can see that prizol isn’t anti-ulcer agent but when we go to immune okay there’s a connazole okay that is a systemic anti-fungal okay and in neuro we see piprazole which is a psychotropic.

"Searchable documents make it a lot easier for you to find it much more comprehensive. But in terms of usability, I might use the one before it. But when we’re talking about the same mechanism of action, if we see the same endings, then we’re going to have the same mechanism of action likely. Okay, but you have to kind of go a little bit into the weeds because if you have, for example, esomeprazole and omeprazole, well you actually have two proton pump inhibitors and both of the physicians were thinking, ‘Hey, you know I want to reduce this patient’s gastric acid.’ One gave them one medication and the other one gave him the other and they both didn’t mean to give the same type of medication. But if a patient is on let’s say Omeprazole and fluconazole and aripiprazole for a GI issue, an immune issue, well it’s an antifungal and then we’re also talking about an antipsychotic then well we may have physicians that all three want to write those medications and those are not duplicates but that again is what the memorizing pharmacology books are all about making sure that you can not only understand memorize the medications but also increase your patient’s safety. Okay so that was 2.2a maybe I went a little bit too deep into that one but the bottom line is same mechanism of action you want to clarify with both prescribers here is critical thinking activity 2.

2 B okay a nurse is preparing to administer metoprolol, a cardiac medication to a patient and implement the nursing process assess the vital signs prior to administration and discovers the heart rate is 48 so patient is bradycardic diagnosis that the heart rate is too low to safely administer the medication for the parameters provided establishes the outcome to keep the patient’s heart rate within the normal range of 60 to 100 so again below 60s bradycardic above 100s tachycardic plans to call the physician as well as report this incident in the shift handoff report implements interventions by withholding metoprolol at this time documenting the incident that the medication is withheld and notifying the provider continuous to evaluate the patient’s status throughout the shift after not receiving the metoprolol. The nurse is providing patient teaching to a patient about the medication before discharge. The nurse provides a handout with instructions as well as a list of current medications what other information should be provided to the patient? Well here what we’re going to do is uh we’re gonna make sure to let them know hey when are you need to take the medication what kind of side effects you’re going to watch out for uh and adverse effects and then maybe there’s diet over-the-counter restrictions herbal supplement restrictions as well but let’s just give one so with beta blockers one of the things that is maybe a little bit of a surprise to something called exercise intolerance where all of a sudden patient goes home goes tries to exercise like whoa what is going on I just did not feel "Like myself, that’s something they should know before they go home with the medication that okay that’s gonna happen with a beta blocker that will reduce you know heart rate very sometimes significantly and that’s kind of one of the things that should be in there. The other thing is to make sure that you’re looking at the patient so if the patient is diabetic okay beta blockers mask this signs and symptoms of hypoglycemia because normally a hypoglycemic patient would get a rapid heart rate and kind of get tremors and those types of things and if that’s not the case then the patient might not realize that they’re hypoglycemic so that’s another one of the counseling points to put in there. So that kind of tiredness that a patient might feel is going to be somewhat normal with a beta blocker especially at first and then if a patient’s diabetic want to make sure that they know that the signs and symptoms of hypoglycemia might be covered up. All right critical thinking activity 2.

3 A Levofloxacin is an antibiotic that received FDA approval however the drug was on the market it was discovered that some patients who took levofloxacin developed serious irreversal adverse effects such as tendon rupture. The FDA issued a black box warning with recommendations to reserve levofloxacin for use in patients who have no alternative treatment options for certain indications uncomplicated UTI acute exacerbation of chronic bronchitis acute bacterial sinusitis. A nurse is preparing to administer medications to a patient notices that levofloxacin has been prescribed for the indication of pneumonia there’s no other documentation in the provider’s notes related to the use of the medication what’s the nurse’s best response? So we’ll give you a second since this is not one of the normal indications we’re going to want to first clarify that the prescriber whether a nurse practitioner or physician whatever really meant to give levofloxacin for this patient that’s the first thing we’re going to do um and then we want to make sure that we document that then if it is a go ahead then we want to make sure we tell the patient okay take the levofloxacin with water make sure you take it at the same time each day you can take it with or without food but the patient should be told that they need to avoid dairy products like you know milk yogurt things like that at least two hours before or after because it will chelate or bind with um those types of things and make it much less effective it’ll also bind with things like antacids calcium carbonate and magnesium hydroxide aluminum hydroxide and and I didn’t want to go into the weeds with that but the idea is that multivalent cations multivalent again this is why chemistry is so important so multivalent means it’s plus two or plus three multi meaning many and so if you look in group two of the periodic table group theory of the period three of the periodic table in group two you see calcium and magnesium and in group three you see aluminum and so if you see those those are going to bind with the levofloxacin or fluoroquinolones more generally and they’re going to make them ineffective so that’s if you get the go ahead from the prescribed okay let’s go on to critical thinking activity 2.

3 B A nurse is providing discharge education to a patient who has recently had surgery and has been prescribed hydrocodone with acetaminophen tablets to take every four hours as needed at home. The nurse explains that when medication is no longer needed when the post-op pain subsides should be dropped off at a local pharmacy for disposal in a collectible receptacle."

In a collection receptacle, the patient states, ‘I don’t like to throw anything away. I usually keep unused medications in case another family member needs it.’ What is the nurse’s best response?

'Alright, well the first thing is we really don’t want to share medications. It is illegal, especially with controlled substances like hydrocodone with acetaminophen, which is Vicodin or Lortab. Not only does the other patient, we don’t know what other issues they might have. For example, let’s say that a patient has trouble breathing or just something like that. You can have respiratory depression if you take too many of these. So what we want to do is talk about the dangers of potential drug interactions, dietary interactions, other side effects of the medication for themselves where the prescriber and the nurse have already looked at their record. But to give a medication to someone and you haven’t even evaluated the other medications, that would be irresponsible and in this case also illegal.

Let’s do number two or part two here. A nurse begins a job on a medical surgical unit. One of the charge nurses on this unit is highly regarded by her colleagues and appears to provide excellent care to her patients. The new nurse cares for a patient that the charge nurse cared for on the previous shift. The new nurse asks the patient about the effectiveness of the pain medication documented as provided by the charge nurse during the previous shift. The patient states, ‘I didn’t receive any pain medication during the last shift.’ The nurse mentions this incident and the preceptor states, ‘I’ve noticed the same types of incidents have occurred with previous patients but didn’t want to say anything.’ What’s the new nurse’s best response?

‘Well this is an issue where we may have an impaired nurse and this could obviously endanger the patient and themselves to be honest. So it’s their obligation to report suspected drug use to the nurse manager and supervisor and then in maybe in some cases to the board of nursing. But if that happens and certainly if it happens on a consistent basis then it’s not to take it on your own. It’s to talk to the right people about this and kind of go from there.’

Alright, critical thinking activity 2.3 C: A nurse is preparing to administer morphine, an opioid, to a patient who recently had surgery.

1. Explain the five rights that the nurse will check prior to administering this medication to the patient.

2. Outline three methods the nurse can confirm patient identification.

3. What should the nurse assess prior to administering this medication to this patient?

4. Which should be monitored after administering the medication?

5. Which should the nurse teach the patient and/or family member about the medication?

6. What information should be included in the shift handoff report about this medication?

Alright, let me re-read each question each time I do this just because there are a lot of pieces to this.

So number one: Explain the five rights that the nurse will check prior to administering this medication to the patient.

The five rights are: right patient, right medication, right dose, right route, right time. And then of course we’re going to want to make sure that we check the expiration date and check allergies although it’s not on here. A sixth right is correct or right documentation as well.

The second question said: Outline three methods that a nurse can confirm patient identification.

Let’s kind of break this up: You could scan a barcode on both medication and patient’s armband if they have it; you can ask their name and date of birth; you could just check their armband or identification band itself.

But sometimes you’re going to be in settings like long-term care where there might not be an armband and also if you’re talking about dementia patients they may not know their name or date of birth so what we want to do is maybe if their medication record has an image of them that would be one way to do it but probably the best way is to get somebody who is working there as well Here is the corrected version of your text:

"And say, ‘You know, I think this is such and such,’ or just say, ‘Look, I know who I think this person is. I just want you to identify them to match it so that you don’t already say, hey, this is this person.’ The person says, ‘Yeah, that’s that person.’ What we do in the pharmacy is we’ll generally ask for somebody’s address and that’s just an innocuous way of saying, ‘Okay, we have the same person.’ So Tom Smith, we’re just hoping that Tom Smith and Tom Smith don’t both live in the same place or in the same address. And even if they do live in the same building like we’re in some place like New York where you could have many people living in the same building, making sure to pay attention to the apartment number or something like that.

Alright, what should the nurse assess prior to administering this medication to the patient? So we weren’t really that specific. We just said it was some kind of opioid so we know that there’s going to be some issue with pain. So what’s the patient’s pain level? Are they conscious and alert? What’s their respiratory rate? Again, we know that an overdose of opioids can reduce the respiratory rate cause respiratory depression. And then are they oxygenating? So what do we do then if there is a respiratory rate that’s decreased or an oxidation level that’s decreased or sedation is too high? We want to make sure that we contact the prescriber, talk about withholding the medication things like that. And then of course if there’s some kind of overdose.

I definitely want to start talking about interventions. Number four: What should be monitored after administering this medication? Well again, we’re monitoring respiratory rate, that oxygenation level, the sedation status. And then you know, is it effective in treating the pain? You know, is it doing its job?

Okay number five: Which should the nurse teach the patient and/or family member about the medication? So this would be the common side effects and we’re not talking about toxicity. We’re talking about patient’s probably going to be constipated and this would be a good time to check the medication record to make sure that maybe there’s some docusate sodium on board or something like that. Some degree of laxative that’s going to help them or a stool softener. And then let them know that drowsiness is going to be something that does happen but also to maybe let them know okay well what are the signs of toxicity where we would be going kind of a little bit further than the common side effects.

And then the sixth one was: What information should be included in the shift handoff report about this medication? So again we’re talking about the pain. Where is that pain coming from? What’s the pain level? What medications were given and what times during the shift? And then how did the patient respond? Is the patient comfortable? Is the patient doing well?

Alright let’s go on to 2.3 D: Okay a nurse is disciplined by the Wisconsin Board of Nursing for an incident reported by her employer that she arrived to her shift intoxicated. Then our shares with a nursing colleague: ‘I love taking care of patients. I work so hard to obtain my nursing license. I don’t want to lose it. I know my drinking has gotten out of control but I don’t know where to turn.’ What is the best advice by a nursing colleague for this patient with a drinking problem?

Well most boards are going to have some level of assistance so in Wisconsin you’d have a professional assistance procedure where a patient committed to recovery is able to get treatment and support. And what we want to do is prioritize patient safety but also acknowledge that a nurse has rights as well to get help especially if she’s committed to recovery.

Alright, question 2.4: A nurse is providing education to a mother regarding a liquid antibiotic prescribed for her child to take at home. The prescription states amoxicillin 250 milligrams one teaspoonful (5 mL) every eight hours for seven days. After talking with the mother, the nurse realizes the family does not have measuring spoons in their home. What is the nurse’s best response?

So this is a really common thing that happens especially when maybe you have a spoon that gets lost or someone just forgot their medication itself. If you go to any pharmacy, they’ll give you a syringe. You don’t have to ask, ‘Do I need to pay for a syringe?’ I mean, you could buy one, but just go up to the counter and say, ‘Hey, can I just get a measuring spoon or a syringe?’ Now to be fair, the syringe is actually a bit more accurate. I don’t want to say it’s necessarily more accurate, but the data show that patients do better with the syringe than they do with the measuring spoon in terms of giving the appropriate dose. So going to a pharmacy to get this, don’t try to use the spoons at home. The tablespoons, the teaspoons, that is not the way that you want to do it to make sure that the patient, especially a child, gets the right medication.

Alright, we’re in our last section. We’re going to do two more critical thinking activities.

Activity 2.5 A: The nurse is performing medication reconciliation for an elderly patient admitted from home. The patient does not have a medication list and cannot report the names, dosages, and frequency of the medication taken at home. What other sources can the nurse use to obtain medication information?

In this case, what we’re going to do is we’re going to try to compile everything for them. Often in the pharmacy world, we’ll have brown bag events where the patient just kind of brings all their medications including over-the-counter stuff. We don’t want to exclude that. We don’t want them to just bring prescribed medications and what we want to do is make sure that we compile them into a list that we can print out for the patient so that when they go to their next provider they can provide this list to them. Again, the medications will change and things like that but making sure that all the medications are correct and appropriate. That we don’t have medications they were using before they don’t need anymore and then making sure that they go home with the list.

Critical Thinking Activity 2.5 B: A nurse is preparing to administer insulin to a patient. The nurse is aware that insulin is a medication on the ISMP list of high alert medications. Which strategy should the nurse implement to ensure safe administration of this medication to a patient?

So of course, we’re going to use the five rights. We’re going to want to make sure that the blood glucose level is where we want it to be. What type of insulin are they taking? Concentration? When was it opened? So we want to make sure that it’s good and then also what kind of storage was happening with the medication? The nurse should draw the dose; they can confirm the correct dose with another nurse prior to giving it; and then knowing the onset peak and duration of action to monitor for potential side effects like hypoglycemia which is quite common with insulin unfortunately.

But let me show you a page of memorizing pharmacology so that you can kind of see where memorizing some of these insulins would be really useful.

Okay when you’re looking at this and you’re working on memorizing these you want to memorize them in order some kind of order in this case with insulin you want to memorize the rapid acting those that start working in 15 minutes last about four hours those are going to work so quickly you’ve got to make sure that the patient has a meal so we’re talking about insulin lice Pro or Humalog something like that short acting Works in about 30 minutes and this lasts about six to eight hours and this is regular insulin Humulin R.

The intermediate NPH Humulin N about an hour or two last 14-24 hours and then that long duration insulin glargine Lantus and Tujeo those start working about an hour and last about 24 hours but when you memorize them you want to remember Humalog then Humulin R and Humulin N then Lantus or Tujeo.

We want to do that in order put them in your brain in order because then when you’re saying okay I’m giving insulin if you’re giving Humalog you know okay well I’ve got to talk to the patient about what they’re eating with R you know that there’s maybe some kind of "Know titration up or down where you know maybe we’re kind of looking at their blood glucose first and then giving our NPH should be given to you know kind of control insulin levels over a much longer period of time and then certainly insulin glargine you know are we giving it you know at night time or daytime uh which time are we kind of choosing uh to do that so my advice is when you get to that insulin and you know that insulin can be you know life-saving but it can also be very dangerous memorize them in order Humalog, Humulin R, Humulin N and then Lantus or Tujeo.

And just to be clear this is the book that I’m talking about it’s right here: Memorizing Pharmacology Relaxed Approach Second Edition. And this was the Kindle version. The audiobook obviously is gonna you know narrate those types of things but I just want to make clear this is where this is coming from.

Alright well let’s kind of go back to the beginning here so again this was a nursing pharmacology lesson this was chapter two legal and ethical and the next thing you do is go into antimicrobials which is chapter three and I’ll talk a little bit about the way that I teach and the way that I put them in order.

I always put my classes and then I ask the patient, the patients I ask the students to always put their groups in order so they would put um gastrointestinal musculoskeletal respiratory immune neurocardio endocrine. I asked them to always put the medications on the patient’s med list in that order so that they can look for duplicates and things like that and then when they’re studying for and collect snat applex whatever it is they’re studying for to also continue to study in that order so that in your brain you kind of have these partitions and you know okay the first partition is GI the second partitions musculoskeletal the third partition is respiratory because I think it gets confusing when you use multiple books or multiple resources and you’re in a different order but so if you need my help or want to get in touch with me Tony the pharmacist gmail.com. I hope you’ve enjoyed this episode and hope it’s been helpful.

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

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

This is Chapter 1, Part 3 of the Critical Thinking cases in Chapter 1 of the OER Nursing Pharmacology book where I go over a little more detail on the answers to help you better understand pharmacology with the engagement of small case studies. 

Looking for a book to help with pharmacology, check out Memorizing Pharmacology, A Relaxed Approach Second Edition 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

This is Chapter 1, Part 2 of the Critical Thinking exercises in Chapter 1 of the OER Nursing Pharmacology book where I go over a little more detail on the answers to help you better understand pharmacology with the engagement of small case studies. 

Looking for a book to help with pharmacology, check out Memorizing Pharmacology, A Relaxed Approach Second Edition 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

Video OER Pharmacology Cases and Critical Thinking Chapter 1 Kinetics and Dynamics Part 1

This is Chapter 1, Part 1 of the Critical Thinking exercises in Chapter 1 of the OER Nursing Pharmacology book where I go over a little more detail on the answers to help you better understand pharmacology with the engagement of small case studies. 

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:

Hey, welcome to the Memorizing Pharmacology podcast. I’m Tony Guerra, a pharmacology professor and author of the Memorizing Pharmacology and Memorizing Pharmacology Mnemonics series of books. What we’re going to do today is go over the critical thinking activities in chapter one of this Nursing Pharmacology OER book. That is, it’s an open educational resource so you can get it for free if you like. We’re just going to go over the critical thinking activities in the first chapter. So, we’re not going to be skipping around as much as we’re just going to kind of zero in on those activities that really focus on critical thinking. If you want more information, you can always go back to the book itself to check it out.

So, the way it works is we’re just going to go here and we see okay critical thinking activity 1.5. Metabolism can be influenced by many factors within the body. If a patient has liver damage, the patient may not be able to break down or metabolize medications as efficiently. Dosages are calculated according to the liver’s ability to metabolize and the kidneys’ ability to excrete. When caring for a patient with cirrhosis, how does this condition impact the doses prescribed for the patient?

So when we have somebody that has cirrhosis, the first thing we’re really kind of saying is that the liver is damaged right? So if these transformations or biotransformations as we call them are in the liver and normally are taken care of by liver enzymes and those liver enzymes are damaged and so forth then they’re not going to work as well.

So what happens? Well, what we really want to talk about here where if you have less and if you have more ability to metabolize these medications. So let’s think about it this way: The liver can normally metabolize some amount of medication right? If it’s damaged, it’s gonna be like when you’re at work and there’s one less person there and you can’t get things done as quickly.

So for example, it’s very often that you know you’re in a restaurant and they’ll tell you hey you know we just don’t have enough waiters tonight sorry times are a little bit slow okay all right so your food isn’t going to get there as quickly. When we’re talking about metabolism and medications that means that we’re going to have more or less medication hanging around.

Well if the liver’s job is to break down the medication then that means we’re actually going to have more medication sticking around okay and that means that we need to do what with the dosage? Okay, the dosage needs to go down because the amount of medicine still in the body because the liver can’t break it down is going up okay so we’re basically lowering dosages to decrease that toxicity okay.

So again as we go through these critical thinking activities you can kind of stop the recording say okay well let me try to answer it and then kind of go from there okay so we’re in now excretion so if we’re thinking about pharmacokinetics we have absorption distribution metabolism and excretion.

The liver is the organ that is most associated with the breakdown of medications or transformation of medications and Metabolism but when it comes to an excretion we’re talking about now how good is the kidney function okay so when providing care for a patient who has chronic kidney disease how does this disease impact medication excretion?

Well if many of these medications and metabolites, the kidney filters them when we are not able to get rid of them okay we might find that we are now getting reserved back into the bloodstream. The kidneys aren’t working they’re just kind of hanging around hanging around and we have a very similar effect to the liver but just to be clear: The liver hasn’t been able to break it down and we keep more medication around with chronic kidney disease.

The medication excretion okay is going to be slowed down because we just can’t get rid of it. The kidney is damaged okay all right let’s go on to the next one pharmacodynamics so we have pharmacokinetics and pharmacodynamics pharmacokinetics is really the absorption distribution metabolism and excretion pharmacodynamics now we’re going to talk a little bit about how a medication and its effects are going to create a need for an assessment or different type of assessment.

"Administration, well, let’s start by defining that word, inotropic. Okay, inotropes are generally going to increase or decrease the strength of contraction of the heart. Whether it’s a positive inotrope where it increases the strength of contraction or a negative inotrope where it reduces the strength of contraction. So, digoxin is a positive ionotrope. Other ones include dopamine, dobutamine, adrenaline or adrenaline. Those are positive ionotropes increasing the strength of contraction. Negative inotropes include like amiodarone.

Amlodipine, carvedilol, metoprolol, propranolol, ramipril, valsartan those types of things. So when we’re talking about these medications we’re looking and saying okay we have a beta blocker this is a negative ionotrope this is going to reduce the force of contraction okay but what’s it going to do as far as its chronotropic effect so again we want to define well what is a chronotropic effect so a positive chronotrope is one that’s going to increase heart rate get you closer to tachycardic and then a negative chronotrope is one that’s going to reduce heart rate it’s going to get you closer to bradycardic and again to define that bradycardia is right 60 beats per minute tachycardia is 100 beats per minute.

So to give you some examples if we talk about the positive chronotropes we would think like atropine, dopamine, dobutamine, epinephrine. If we think about the negative chronotropes we’re talking about digoxin, diltiazem, varapamil, metoprolol but really we could say beta blockers in general so it’s important that we see that atenolol has negative inotropic and chronotropic effect so what should the nurse assess before administration now that we know what these are for well it’s reasonable that if you’ve got something that’s going to reduce heart rate and maybe reduce heart blood pressure then the first thing that we want to do is we want to assess the patient’s pulse and blood pressure and make sure they’re normal.

What we don’t want to do is have somebody that maybe is already bradycardic and bring them even down lower okay now I run marathons or I run long distance so my normal heart rate is probably in the 50s so they would just check okay well that’s normal that’s fine it’s not that something is happening okay but that’s what we would do.

Alright let’s go on to 1.9 we have two parts to this one first at 05:00 number one at 05:00 your patient who had a total knee replacement yesterday rates his pain while walking at seven out of ten physical therapy is scheduled at nine patient oh 09:00 okay so 9 A.M. to us the patient has acetaminophen Tylenol 625 milligrams ordered every four hours as needed for discomfort what should you consider in relation to the administration and timing of the patient’s pain medication.

So there are really three things that we’re going to do here first we have 05:00 okay that’s what time it is now okay the patient needs medication will give them medication now right we know they’re going to need it in about four hours so what we can do is after about an hour check with the patient see how they’re doing see if their pain is improved then just before the physical therapy session we want to make sure that they get their medication because we don’t want them to have one dose at five then four hours later start their physical therapy session and be in pain while that’s happening so we want to make sure it’s a little ahead of time.

The last thing we want to do is we want to make sure that we don’t exceed the maximum Tylenol for the day and there’s a couple of numbers here generally we say that we really don’t want to be above 4 000 but if you actually talk to the makers of Tylenol they would prefer that number be even closer to 3 000 a much safer amount if the patient and this isn’t in the paragraph but if there were some alcohol disorder or patient as a drinker we would want to reduce that Tylenol even more because we want to be careful with the liver.

So 05:00 patient had a total knee replacement yesterday pain walking seven out of ten physical therapy scheduled at nine. We give the first dose at five then we check with them about an hour later make sure that it’s working then just before the physical therapy we give them another dose okay then four hours after that they’ll get another one and what we’re making sure is throughout the day that the patient isn’t going over the amount they should have now.

"We can do a quick calculation here if 625 is ordered every four hours let’s see what that total would be and I know what it is I can do it in my head but I’m just saying let’s let’s get the Google Calculator. Okay, so the first thing we want to do is we want to be careful we don’t multiply the 625 times 4 because it’s every four hours we would multiply the 625 times 6 and we see that that number 3750 milligrams is right there between three thousand and four thousand and what we want to make sure is that okay maybe it’s around the clock but maybe it’s not because this isn’t for inflammation Tylenol doesn’t acetaminophen doesn’t help with inflammation if the patient can sleep through the night then okay maybe one of those doses we won’t use will get a lot closer to that 3000 number or maybe it’ll go out a little bit further closer to the five hour mark something like that and we get down to three thousand but we’re really hovering on the edge so this is where we really want to be careful if someone says okay well the pain isn’t being taken care of let’s add some Vicodin or something like that and Vicodin in it or vicoprofen would have an additional or Vicodin not vicoprofen Vicodin would have an additional amount of acetaminophen so we definitely want to be careful of that okay.

Alright, well let’s look at the second one here. Number two, your patient is prescribed NPH insulin to be given breakfast and supper. As a student nurse, you know that insulin is used to decrease blood levels in patients with diabetes mellitus. During a report, you hear that this patient has been ill with GI upset during the night and the nursing assistant just inform you he refused this breakfast tray. While reviewing this medication order, you consider the purpose of the medication and information related to the medication onset peak and duration again we’re talking about the NPH insulin right now when reviewing the drug reference you find that NPH insulin has an onset of about one to three hours after medication administration. What should you consider in relation to the administration and timing of the patient’s insulin?

So let’s take a minute to think about it. Alright, so you’re back and let’s think about this. So the insulin is supposed to decrease blood sugar levels but the patient’s stomach’s been hurting quite a bit and he’s just not hungry. Well wait a minute, insulin can be used to reduce blood glucose levels but our expectation is that glucose levels are going to be increased each time the patient eats. If the patient is not eating well then we need to really make sure that we’re not going to cause hypoglycemia. So again hyperglycemia is glucose that is too high in the bloodstream hypoglycemia is when it’s too low so insulin is one of those high alert medications and so if this continues to happen, the patient keeps refusing the food but keeps getting the insulin, we could be in a lot of trouble so we want to make sure that we work with the patient make sure that we’re checking if they’re eating and make sure that the insulin dose is appropriate for how much they’re eating and we would do that by doing some blood glucose tests throughout the day to make sure that those blood glucose and blood sugar levels are where we want them to be.

Alright, here is critical thinking activity 1.10 a Mr Parker has been receiving Gentamicin 80 milligrams this is under medication safety has been receiving Gentamicin 80 milligrams IV three times daily to treat his infective endocarditis he has his Gentamicin level checked one hour after the end of his previous Gentamicin infusion was completed. The result is 30 micrograms per ml based on the results in the above patient scenario what action will the nurse take based on the result of the Gentamicin level of 30 micrograms per ml okay so I’ll give you a minute.

Alright, the normal lab value okay that’s kind of the first thing that we have to do okay it’s like five to ten mcgs or micrograms per ml right or if you’re using micro moles it’s like 10 to 20. It’s a little higher okay per liter what we can do is see if this patient has good kidney function there might be some kind of renal impairment that is not helping with excretion and we need to make sure that we adjust the dose on the next time so again we’ve got a result. We compare the result to the normal Gentamicin levels, we see that the level is high and now we’re going to check maybe kidney function what’s going on because Gentamicin itself is ototoxic damaging to the ears but also nephrotoxic and can actually damage the kidney itself.

Alright, I’m actually going to stop it there before we go to 1.12 module learning activities. I think that you know that 15 minutes or somewhere between 15 and 20 minutes is a good amount of time so again you can go to the nursing pharmacology book and we went through 1.5 metabolism, 1.6 excretion, 1.7 pharmacodynamics, 1.9 okay we’re examining the effect, 1.10 medication safety okay so again if you want to check out a course on pharmacology that has all those mnemonics and things like you’re welcome to check out the self-paced pharmacology course with mobile quizzes and videos at residency.teachable.com forward slash P forward slash mobile and you can always get half off h-a-l-f-o-f-f again it’s h-a-l-f-o-f-f to get half off.

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Peptic Ulcer Disease Triple Therapy Mnemonic

Here's the Mnemonic for Peptic Ulcer Disease Triple therapy that can include PPIs and H2 blockers in addition to the ones listed in the actual mnemonic. The important thing is that we reduce acid and kill the H. Pylori bacteria to help institute ulcer healing.

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Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. I’m excited to bring you another mnemonic that’s going to help you through pharmacology class. So, what I wanted to do is talk a little bit about Peptic Ulcer Disease where we’re going to have these triple and quad therapies. In this section, we’re going to talk about the triple therapy where you take a couple of antibiotics and you add something to reduce the acid and there are a number of choices that you can make. So, I just wanted to be clear that it doesn’t have to be this proton pump inhibitor. There are many proton pump inhibitors that you can use and some prescribers even use H2 blockers such as Famotidine and so forth. So, as we go through this lesson, think of it more as what kind of antibiotics am I going to use and what kind of acid reducers would I use more generally and then have a better understanding of how we protect the stomach and allow it to heal and get rid of the ulcer.

Question number six: Name three antibiotics in a triple Peptic Ulcer Disease regimen and how we dose the PPI? Number six: Triple Peptic Ulcer Disease (PUD) therapy. We’ll use the mnemonic ‘aced PUD’. ‘A’ Amoxicillin brand name Moxatag, ‘C’ Clarithromycin brand name Biaxin, ‘E’ Esomeprazole brand name Nexium, ‘D’ Double dosing of the PPI.

Quick summary: Triple therapy means we are using three drugs usually one acid reducer and two antibiotics. Quad therapy adds another antimicrobial for four drugs in total. After a recent update to H pylori preferred drug regiments, a round of first-line triple therapy now includes Metronidazole but it would be confusing to throw it in this mnemonic.

Peptic Ulcer Disease describes ulcers that develop in the stomach or duodenum and extend deep into the mucosa. Ulcers can lead to GI bleeds. Three main Peptic Ulcer Disease causes are stress, NSAID use, and H pylori - a helicopter-like organism that burrows into the stomach lining.

The Mainstay treatment for H pylori ulcers includes antibiotics to wipe out infection and ppis to reduce acid. Treatment typically lasts 10 to 14 days. Traditionally, H pylori infection treatments have included triple therapy - a PPI, Amoxicillin, and Clarithromycin.

For triple therapy, I used ‘Ace’ as the mnemonic as the three-drug combination aced killing Helicobacter pylori - the causative organism. You can include any of the ppis in the treatment regimen but Esomeprazole’s ‘E’ made creating mnemonics easier.

‘A’ Amoxicillin - a penicillin antibiotic. The ‘cillin’ stem lets us know Amoxicillin is a penicillin antibiotic with Amoxicillin side effects we worry about penicillin allergic patients.

‘C’ Clarithromycin - a macrolide antibiotic. Clarithromycin has a throw T-H-R-O substance with mycin M-Y-C-I-N as a suffix or you could look at the throw T-H-R-O which rhymes with the crow CRO in macrolide. Be careful with mycin it only lets you know the bacteria comes from the Streptomyces class but it does not tell you the antibiotic class.

For Clarithromycin, we think of the metallic taste and QT prolongation.

‘E’ Esomeprazole - a proton pump inhibitor.

And ‘D’ Double dosing of the PPI means we use bid twice daily dosing rather than traditional QD once daily dosing.

Why do we use two or three antibiotics?"

If you use more than one antimicrobial, you can reduce resistance and decrease dosages to lower the risk of side effects. Why do we use quad therapy? If a patient is penicillin allergic, we might use the bed M regimen which we’ll look at next.

Alright, let’s continue with a couple of quiz questions from the teachable course. What are two antibiotics used in triple therapy to treat Peptic Ulcer Disease? Is it Vancomycin and Cefepime, Amoxicillin and Clarithromycin, Cefdinir and Ciprofloxacin or Tobramycin and Levofloxacin? Yep, if you answered Amoxicillin and Clarithromycin, you can check your answer and that is correct.

Alright, continuing to the next question. How do you dose a proton pump inhibitor in triple therapy to treat Peptic Ulcer Disease? Do you have the dose triple the dose double the dose or quadruple the dose? So again, how do you dose a proton pump inhibitor in triple therapy to treat Peptic Ulcer Disease? Is it half triple double or quadruple? Awesome, if you answered double the dose, you can check that. You see that it is correct.

And what you want to do is you want to make sure you get that significant acid suppression to help that ulcer heal. Again, if you want to continue on in a course that helps you out in Pharmacology, there’s really three ways that I’ve kind of set it up. You can just get the audiobook Memorizing Pharmacology: Relaxed Approach Second Edition. Again, Audible’s very good about giving you a free book if you’ve never been with Audible before.

You can take a self-paced pharmacology course with mobile quizzes and videos. You can always get half off with the discount code H-A-L-F-O-F-F all caps at residency.teachable.com forward slash P forward slash mobile or you can take a pharmacology class with me at Des Moines Area Community College completely online completely asynchronous it’s PHR185 Pharmacology and you can find that by just hitting really the easiest ways to just put in DMACC pharmacology in the Google box and you’ll get to it.

But if you’ve got questions I’m always happy to send emails back. A lot of people have me help them with their homework too if you’re having some struggles with pharmacology and there’s a question or two that you really don’t understand why it was right or wrong or something like that Tony the pharmacist gmail.com I’m happy to help you out again I just want you to succeed need in Pharmacology okay thanks again for listening to the memorizing pharmacology podcast excited to have you again make sure to get on our email list at residence not at residency.teachable.

Com but at memorizingfarm.com okay just go down to the bottom and then you can get our best pharmacology cheat sheet I just your first name and an email address just so we can keep in touch and that pharmacology cheat sheet again has the suffixes and prefixes for over 350 medications making it a lot faster to learn pharmacology thanks for listening.

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