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All right, so let's talk farm. 
One of the biggest topics that 

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comes up on the boards and in 
nursing school and in real life 

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is toxicity. 
So the pneumonic that I came up 

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with is warning these drugs are 
pretty lethal. 

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So what does that stand for? 
West? 

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Warning Warfarin, these 
theophylline drugs, Digoxin RI 

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added acetaminophen because it's
so commonly consumed that we 

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have to also make sure that they
don't overdose with the 4 grams 

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a day. 
And then warning, these drugs 

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are pretty phenotoin lethal 
lithium. 

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So let's talk about each one of 
these real quick. 

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So warning warfarin, well, it's 
a blood thinner, so we got to be

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careful. 
The therapeutic therapeutic 

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index for warfarin is actually 
two to three. 

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Do you want your INR between 
2:00 to 3:00? 

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So what is the antidote if we 
start to go over that and or we 

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see bleeding issues, well, it's 
going to be vitamin K warning 

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these theophylline. 
So theophylline is a drug that 

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we're going to use in 
respiratory and it's we want the

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therapeutic index between 10 and
20 micrograms. 

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So there's not a lot of room for
error. 

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If you notice that micrograms 
per milliliter very, very, very,

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very careful with that drug and 
the antidote for that is going 

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to be activated charcoal. 
So it limits the absorption of 

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it. 
And so again, the antidote very 

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important knowing that it's a 
very toxic drug. 

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So warning these drugs, digoxin.
So digoxin has a very, very 

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narrow therapeutic index. 
So it's going to be between 0.5 

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to 2 point O nanograms. 
So really, really small 

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therapeutic index. 
And if we do end up getting 

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toxic, which there's a lot of 
issues with digoxin, 

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neurotoxicity, cardio toxicity. 
So we've got to be very careful 

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in monitoring these patients and
educating these patients because

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the heart rate drops as well 
too. 

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So there's a lot of negative 
things with digoxin. 

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So we have to know them and the 
boards love them because of 

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that. 
And what do we give them? 

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We give them digoxin, immune 
fab. 

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That's going to be your 
antidote. 

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Then we've got warning. 
These drugs are so 

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acetaminophen. 
We've got to be very careful 

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because 4 grams a day is going 
to be hepatotoxic. 

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And why is that important? 
Because what, like I said, it's 

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consumed over the counter, but 
if you look at the pills, some 

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of the doses for the extra 
strength are 500 milligrams. 

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So that leaves you with how many
doses? 

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88 pills? 
That's it. 

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So we've got to be very careful 
with that. 

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And the antidote for that is an 
acetylcysteine. 

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So warning, these drugs are 
pretty phenotoin. 

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So with phenotoin, we have a 
therapeutic index of 10 to 20, 

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again, micrograms. 
So we don't have a lot of room 

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for errors. 
A lot too. 

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But the thing about phenotoin is
there's not really an antidote 

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for it. 
So what are we going to do? 

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Hydrate, hydrate, hydrate and 
monitor, monitor, monitor. 

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So supportive care as an 
antidote for phenotoin. 

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So one of these drugs are pretty
lethal and the last one is 

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lithium. 
So with lithium, we have a 

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therapeutic index, a therapeutic
index of 0.6 to 1.2 milli 

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equivalents per liter. 
But again, with lithium, there's

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not really an antidote. 
So what are we going to do? 

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Hydrate, hydrate, hydrate. 
Get it out of the system and if 

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it gets really bad, then we have
to do a hemodialysis. 

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So these drugs are very lethal. 
So again, their toxicity is 

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important, their antidotes are 
important, and knowing what 

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they're used for is very 
important. 

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So again, warning, these drugs 
are pretty lethal and farmed. 

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There's only six ways that the 
boards can ask a question. 

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One is identify the drug, 2 is 
antidote, 3 is dosages, if they 

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do that, 4 is contraindications,
5 is side effects and six is 

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education on ways to take them. 
So again, very important to know

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that farm is really not that bad
if you know those six ways that 

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the boards can ask it. 
But these drugs that I just 

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talked about, one of these drugs
are pretty lethal, super high 

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yield. 
So make sure you know them 

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inside out.