please clarify

Priority would be to verify the patient's therapeutic response to the drug, so checking their pulse comes first.

mental status would be a symptom of a side effect that would indicate a perfusion problem. the perfusion problem, however, would be pathophysiologically due to an arrhythmia. one of the things that happens when patients get arrhythmias is the heart and brain may not get enough oxygen. the heart responds by having chest pain; the brain by having mental status changes of different kinds.

i remember having a very cute little elderly male patient many years ago that we had on telemetry that was in some kind of heart block before he got his pacemaker who was insistent that there were bugs crawling all over the toilet in his room. he was so sincere about it and seriously took us all in to the bathroom to point them out to us. of course, we saw nothing. now, he may also have had some atherosclerosis in the vessels of the brain as well contributing to the situation. we had to take him to use a toilet in another room. amazingly, the pacemaker which was inserted the next day made the bugs go away. before i got my pacemaker for sick sinus syndrome i had no outward mental or physical symptoms although i had documented heart rates in the 30's.