All right, so let's talk farm. One of the biggest topics that
comes up on the boards and in nursing school and in real life
is toxicity. So the pneumonic that I came up
with is warning these drugs are pretty lethal.
So what does that stand for? West?
Warning Warfarin, these theophylline drugs, Digoxin RI
added acetaminophen because it's so commonly consumed that we
have to also make sure that they don't overdose with the 4 grams
a day. And then warning, these drugs
are pretty phenotoin lethal lithium.
So let's talk about each one of these real quick.
So warning warfarin, well, it's a blood thinner, so we got to be
careful. The therapeutic therapeutic
index for warfarin is actually two to three.
Do you want your INR between 2:00 to 3:00?
So what is the antidote if we start to go over that and or we
see bleeding issues, well, it's going to be vitamin K warning
these theophylline. So theophylline is a drug that
we're going to use in respiratory and it's we want the
therapeutic index between 10 and 20 micrograms.
So there's not a lot of room for error.
If you notice that micrograms per milliliter very, very, very,
very careful with that drug and the antidote for that is going
to be activated charcoal. So it limits the absorption of
it. And so again, the antidote very
important knowing that it's a very toxic drug.
So warning these drugs, digoxin. So digoxin has a very, very
narrow therapeutic index. So it's going to be between 0.5
to 2 point O nanograms. So really, really small
therapeutic index. And if we do end up getting
toxic, which there's a lot of issues with digoxin,
neurotoxicity, cardio toxicity. So we've got to be very careful
in monitoring these patients and educating these patients because
the heart rate drops as well too.
So there's a lot of negative things with digoxin.
So we have to know them and the boards love them because of
that. And what do we give them?
We give them digoxin, immune fab.
That's going to be your antidote.
Then we've got warning. These drugs are so
acetaminophen. We've got to be very careful
because 4 grams a day is going to be hepatotoxic.
And why is that important? Because what, like I said, it's
consumed over the counter, but if you look at the pills, some
of the doses for the extra strength are 500 milligrams.
So that leaves you with how many doses?
88 pills? That's it.
So we've got to be very careful with that.
And the antidote for that is an acetylcysteine.
So warning, these drugs are pretty phenotoin.
So with phenotoin, we have a therapeutic index of 10 to 20,
again, micrograms. So we don't have a lot of room
for errors. A lot too.
But the thing about phenotoin is there's not really an antidote
for it. So what are we going to do?
Hydrate, hydrate, hydrate and monitor, monitor, monitor.
So supportive care as an antidote for phenotoin.
So one of these drugs are pretty lethal and the last one is
lithium. So with lithium, we have a
therapeutic index, a therapeutic index of 0.6 to 1.2 milli
equivalents per liter. But again, with lithium, there's
not really an antidote. So what are we going to do?
Hydrate, hydrate, hydrate. Get it out of the system and if
it gets really bad, then we have to do a hemodialysis.
So these drugs are very lethal. So again, their toxicity is
important, their antidotes are important, and knowing what
they're used for is very important.
So again, warning, these drugs are pretty lethal and farmed.
There's only six ways that the boards can ask a question.
One is identify the drug, 2 is antidote, 3 is dosages, if they
do that, 4 is contraindications, 5 is side effects and six is
education on ways to take them. So again, very important to know
that farm is really not that bad if you know those six ways that
the boards can ask it. But these drugs that I just
talked about, one of these drugs are pretty lethal, super high
yield. So make sure you know them
inside out.