Antibiotics Test Tips Lecture Notes

Introduction

• Lecture by Nurse Mike from simplenursing.com
• Announcement about new app and course offerings

Top Six Test Tips for Antibiotics

1. Complete the Medication

• Always finish prescribed antibiotics to prevent super infection.
• Important to educate patients not to stop when they feel better.

2. Accidental Pregnancy

• For Sillins (Penicillin) and Cycling (Doxycycline):
  • Keywords: Oral contraceptives are ineffective.
  • Use additional contraception (e.g., IUD).

3. No Alcohol

• Antibiotics can be hard on the liver; alcohol exacerbates this.

4. No Food for Certain Antibiotics (MTF)

• Take on an empty stomach with a full glass of water:
  • M: Macrolides (e.g., Azithromycin)
  • T: Tetracyclines (e.g., Doxycycline)
  • F: Fluoroquinolones (e.g., Levofloxacin)

5. Avoid Sun Exposure (FTS)

• Sensitive to light, which increases risk of sunburn:
  • F: Fluoroquinolones
  • T: Tetracyclines
  • S: Sulfa drugs (e.g., Trimethoprim-sulfamethoxazole)
• Key precaution: Always wear sunblock.

6. Monitor Nephrotoxicity and Ototoxicity (Myosin Drugs)

• Toxicity to kidneys and ears for drugs ending in -mycin:
  • Examples: Vancomycin, Gentamicin, Neomycin.
  • Key monitoring: Peaks and troughs levels.
  • Report signs of toxicity:
    • Ear damage (vertigo, tinnitus)
    • Kidney damage (increasing BUN and creatinine)

Key Considerations for Myosin Drugs

• High levels can cause kidney damage, low levels can allow infections to grow.
• Urine output of less than 30 mLs/hour indicates kidney distress.

Broad-Spectrum Antibiotics: Sillins and Cephalosporins

• Mechanism: Weakens bacterial cell wall, causing death.
• Examples:
  • Sillins: Amoxicillin, Ampicillin
  • Cephalosporins: Cephalexin, Cefazolin

Important Points

• Pregnancy and breastfeeding safety: Both classes are considered safe but require caution.
• Cross-sensitivity: Check for allergies to both classes before administration.

Anaphylaxis and Allergies

• Anaphylaxis is more common with Penicillin.
• During a reaction, assess first then intervene (administer epinephrine).

Administration Tips for Sillins

• Can be taken with food if GI upset occurs. Shake well before use.
• Monitor platelet count for bleeding with Sillins.

Toxic Antibiotic Classes

1. Glycopeptides (e.g., Vancomycin)

• Key monitoring: Thrombophlebitis, red man syndrome (slow infusion).
• Symptoms of concern: Hypotension, flushing, pruritus.

2. Aminoglycosides (e.g., Tobramycin, Gentamicin)

• Monitor for: Ototoxicity and nephrotoxicity.
• Report increasing BUN and creatinine levels.

Macrolides (e.g., Azithromycin)

• Monitor for prolonged QT intervals; can lead to cardiac arrest.
• Also hepatotoxic; monitor liver labs (ALT, AST).

Tetracyclines (e.g., Doxycycline)

• Not safe for pregnancy, can cause tooth discoloration.
• Instructions for patients:
  • Avoid dairy, antacids, and iron.
  • Take on an empty stomach and remain upright for 30 minutes after taking.

Metronidazole (Flagyl)

• First-line drug for C. difficile infection.
• Avoid alcohol during and three days after treatment.
• Common side effects: Dark urine, metallic taste.

UTI Medications

1. Sulfonamides (e.g., Bactrim)

• Monitor for sunburn, urine crystals, and encourage hydration.
• Assess for hypersensitivity to sulfa drugs.

2. Fluoroquinolones (e.g., Levofloxacin)

• Key precautions: Avoid direct sun exposure, monitor for Achilles tendon issues.

3. Phenazopyridine (Pyridium)

• Used for pain relief; turns urine red/orange (normal).
• Report liver toxicity symptoms (jaundice).

Common NCLEX Questions

• Example 1: Best action before administering amoxicillin for patients with allergies to levofloxacin and ceftriaxone: Assess the patient first.
• Example 2: Which medications cause jaundice? Rithromycin and phenazopyridine.
• Example 3: Patient education regarding antibiotics involves monitoring creatinine and BUN levels, avoiding sun exposure, and finishing the full course of antibiotics.