Professional Documents
Culture Documents
Etohism
Things specific to alcoholism. Wornikes and korsoffs: (these are typically different,
but NCLEX seems to put them together bc you may see them both present in the
same patient)
Wornikes= is encepalopothy
Korsoffs=
o #1 s/s= is a psychosis induced by vitamin B1 or Thymin deficiency.
This is when you lose touch with reality and you go insane bc you
don’t have enough B1. These patients are psychotics.
o #2 s/s is amnesia with confabulation. Memory loss and making up
stories. They make up stories bc they forgot and they believe it.
When normal people make up details or whatever bc they have
forgot simple little details this does not mean that everyone who
makes up details or forgets details is psychotic. The difference is that
these psychotic patients believe the details that are made up. These
psychotic patients will forget entire decades of their memory so they
make up stories (like what they did in the 90s) (someone thinks he
was a security officer for ronald Reagan) They have an entire
psychotic story made up about a specific time.
So how do we deal with these people? (someone thinks he is
obamas secretary of defense so he has to get up and go to a
cabinet meeting. We don’t present reality because they cant
learn it bc this is an actual brain deformity. A good thing to do
would be to redirect this patient with something that he CAN
do in place of what he CANT do. He cant go to a cabinet
meeting with the president, but you can say “ lets go get a
shower and afterwards we will go watch the CNN news”
When a patient who has wornskees and korsoffs = we as the
nurse will redirect them.
Characteritics: this is preventable. You never have
to get this in the first place. You can simply take
vitamin B1. Vitamin B1 protects the brain so when
they drink etoh the vitamin B1 prrotects the brain
cells and prevent the entire disease from
happening. Simply put just take their one a day
vitamin in the morning before they start to drink
their etoh and you will be perfectally fine. You can
stop it from getting worse by taking B1. About
70% irreversible. * on boards always go with the
majority meaning….. if a specific disease is 70%
fatal, then you would just say on boards that it is
fatal**
1. When you get an overdose or withdrawl question you need to ask yourself
first is this an upper or a downer drug?
2. Once you know if the answer to the question is either an upper or a downer
The second thing you have to ask yourself is are they talking about is this
question talking about withdrawl(which is not enough) or overdose (which
is too much)?
a. Is the questions being asked either an upper or a downer?
b. Are they talking about withdrawl(which is not enough) or overdose
(which is too much)?
Overdose(too much)- example overdose on an upper: we know that the
answer is going to be all of the upper answers.
DRUGS:
Aminoglycosides
Stopped @70:18/101:54
This is a powerful class of abx, these are the big guns. When nothing else works
the MD will pull out these aminoglycosides. Don’t use these until nothing else
works. NCLEX likes to test on these drugs bc they are dangerous and NCLEX tests
us on safety. Top 5 most commonly tested group of drugs. There are 10 big
groups of meds you must know for NCLEX.
Aminoglycocosides :
Think the following “a mean old mycin” when we hear aminoglycocsiedes. These
are abx that are used to treat “mean old drugs” .
What does that tell us? These are abx that are used to treat serious
infections, life threatening, resistant, gram negative infections. These
“a mean old mycin” is treated by “a mean ole drugs”.
We would NOT use these drugs to tx a sinus infection? NO bc a sinus
infection is not a mean old infection.
TB= yes we would use “a mean old drug” bc this is a “mean ole
infecctiobn”
Otitis media (middle ear infection) = NO we wont use it here.
Bladder infection= no
Fulminating pyleonephrotis = yes use it
Septic shock= yes use it
Infection of 3rd degree of burn wounds over the entire body= yes
Steph throat= no
** use “a mean old mycin” when you have “a mean ole infection”
and no other time but then!**
**ALL aminoglycosides end in “mycin” , BUT not all drugs that end in
“mycin” are aminoglycosides. There are 3 of the mycins that are NOT
aminoglycosides (“a mean old infection”) are:
Arithromycin
Zithromycin
Clarithromycin
** if it ends in “mycin” then it is “a mean old mycin”, but if it has “thro” in it then
throw it off the list it is NOT “a mean ole mycin”
You would use the three above arithromycin, zithromycin, and clarithromycin
drugs for things like sinusitits, but NOT for TB!
What are the two toxic effects of mycin drugs? When we see these drugs think
about the most famous mouse… MICKEY MOUSE… what is the biggest thing on
MM? his ears!!!! So these “mycin” drugs are ALL ototoxic (ear) drugs. “OTO”
means ears. ORO means oral/mouth.
Monitor hearing
monitor ringing in the ears (tinnitus)
monitor Vertigo/dizziness (bc of the the equilibrium and harming the
ear)
but if we had to pick between the three **Hearing** would be the most
important one to monitor for.
The human ear is shaped like a kidney so think the second toxic effect of
these drugs would be nephrotoxicity. NOT daily weight, urine, daily output,
GO for creatinine bc Creatinine is the BEST indicator for kidney fx.
If they ask which one is better the serum creatinine or the 24 hour
creatinine which one is better to show nephrotoxicity? The 24 hour
creatinine clearance would be better to show a better indicator of
nephrotoxicity.
“please feel free to record at 81:20**
So you see the ear/kidney image? Think of the number 8 and that it fits
nicely inside the ear reminds me of two things about the drugs:
they are toxic to cranial nerve number 8 (ear nerve)
you administer these drugs Q8hours.
What is the route for these drugs?
IM or IV
Don’t give these drugs PO bc these drugs are not absorbed! If you give an
PO “mycin” you will just have an expensive poop bc it is not being
absorbed.
Except in two cases we DO want to give these “mean ole mycin” drugs PO:
Hepatic encepalopothy (hepatic coma) liver coma: when the
ammonia level gets too high and it pickles youre brain and you
could die. The tx goal with this is to reduce the ammonia level
in the brain, so oral mycins will do that! and dissolve in youre
mouth, and travel to your gut and destroy gram negative
bacteria in youre gut and sterilize youre bowel. The #1
producer of ammonia in youre body is? Is the ecoli in youre
gut. If I can kill the ecoli in the gut then it will decrease the
ammonia level and it will help with the hepatic coma. Bc these
patients have liver damage w e don’t wont this medication to
get to the damaged liver. If wont get to their liver if taken
orally. It will go in one end and come out the other end and
sterilize the gut.
In preop bowel surgery: you would want to give this oral mycin
drug before bowel surgery bc this medication sterilizes the
bowel before bowel surgery. For a few days before bowel
surgery the pt may take “a mean ole mycin” via PO. Since it is
given PO the patient will NOT have ototoxicity or
nephrotoxicity with this PO medication bc it is given PO in this
situation and is NOT given IM or IV bc given PO it is NOT
absorbed.
In both cases both preop bowel surgery and hepatic encepaloptology what does
the oral mycin drug do? It sterilizes the bowel in both cases. These are called the
“bowel sterilizers”. These two are called Neomycin and Canomycin. Just know
that these two drugs are only used PO and are only used for bowel sterilization.
Remember that by this:
Think of a military cadence. The question the drill sgt asks the troop
is “who can sterilize my bowel?” the troop will shout back “neo can”
for neomycin and canomycin!
________________________________________________________
What is the smallest of Lasix that I have ever seen given? Furisomide. 5 or 10
What is the largest amount of Lasix that I have ever seen given? 120
So is this a narrow or a wide range? Wide range so we would NOT draw a TAP on
them bc this is a wide window range of medication.
When would you draw the trough for IM med? 30 mins before the next dose
PO and IM are both given 30 mins before the next dose.
The peak….
The depends on the route not the drug.
When do you draw a SL peak? 5-10 mins after the drug is dissolved.
IV? 15-30 mins after the drug is finished. Don’t start when you hang the drug.
Start the clock 15-30 mins after the medication is finished given in the bag.
Whenever you get two values in the correct range play the price is right. The
highest person without going over always wins. So always choose the highest
value but within the correct range.
The IM is 30-60 mins after you give it. If Demerol for pain is given and the md
wants to know when the medication is provided relief 30-60 mins what would you
pick? I would pick 60 mins bc it is the highest without going over.
SQ = SEE diabetes lecture ! the only SQ meds they talk about is diabetic meds and
forget about the PO also bc they don’t test on this part.