hey guys nurse Mike here and welcome to simplenursing.com before we get today's lecture started please remember check out our brand new app and get access to our new pharmacology and Med search Mastery courses plus 11 other courses like fundamentals Pediatrics maternity mental health and more complete with over 300 follow along cheat sheets and a massive quiz Bank loaded with detailed rationals to test your knowledge join for free click the link in our description below all right guys let's begin now for the six top test tips for antibiotics guys write these down number one we always finish the med to prevent the super infection we want to prevent creating any super bugs like sea diff or MSA so guys the key words take until all the med is finished and do not stop taking when filling better guys always educate the patient to finish these meds number two is accidental pregnancy for cilins and cyclings so guys remember the three C's child care for cilins like penicillin and cycling like doxic cycling key words here for the enlex is oral contraceptives are ineective so we keyword use additional contraception like an IUD now test tip number three no alcohol guys antibiotics are hard on the liver and so is alcohol now test tip number four no food for MTF so just think move the food M for maids like aiom myosin t for tetracycline like toxic and F for floral quinolones like leof flaxin key words here take on an empty stomach with a full glass of water now number five is no sun so avoid fun in the Sun so remember FTS f for fluorquinolones like lolicin T for Tetra cycling like doxic cycling and a big one here is s for sulfa drugs just think s for sunburns a big drug here is trimethine sulfamethoxazol fancy words for the brand name Baum and other sulfa drugs are sulfuras like GoRide the oral an antidiabetic and even diuretics like thyoides and Loops these have sulfa derivatives so some key words on the exam their photosensitivity which means they're sensitive to light we always avoid direct sun exposure and guys a huge risk for sunburn so wear sun block and avoid the sun now lastly number six Super toxic to the kidneys and ears are the ones ending in mein like ven sin gmias sin and neemias sin guys just think it's a sin to give a Maya sin since they're super toxic so cover your ears and your kidneys so with masin the key points here guys write these down Peaks and troughs if they're too high then the kidneys will die and guys if the troughs too low then the infection will grow so we always report signs and symptoms of toxicity first things first damage AKA autotoxicity keywords for the enlex is vertigo or loss of balance tenius or ringing in the ears and for kidney damage is nephrotoxicity guys we report immediately increasing bu and creatinine those two kidney Labs so creatinine over 1.3 just means bad kidney and guys bu over 20 these numbers should not be increasing now last urine output 30 m mph or less usually means kidneys are in distress now a little side note here don't let the enlex trick you guys mein are the most toxic antibiotics not throw mein like a zosin and not flosin like cypro flosin guys yes they end in sin too but are not myosin so remember mayasins are the most harmful here now for broadspectrum antibiotics are cilins and sporin guys the mechanism of action is that it weakens or destroys the bacterial cell wall causing Lis or death so for penicillin they end incin like amoxicillin or ampicilin and even pillin and tazobactum which is kind of the outlier there now seph Lorin start with seph like seph Xin brand named klex and seph fazolin and even seph triaxone the brand named rosean now both are considered pregnancy safe and breastfeeding safe but there are some specific differences for example penicillin causes accidental pregnancy since it bumps the pill again guys the key words here are oral contraceptives are ineffective and use additional contraceptive like a IUD and C for seths can cause sea diff guys they do not treat it now this was a common test question on hessie and ATI asking for the treatment of ciff no no no guys seths do not treat C so the key point and memory trick here are the three C's C for cross sensitivity or allergy to both seths and sillins guys the key point is checking the allergy before giving either since these drugs are structurally and chemically similar seps and cylin they can't be mixed and an allergy to one usually means an allergy to the other now you can mix nearly every other antibiotic except seths and cylind and 40% of students usually get that wrong on exams so common en clix terms are anaphylaxis reaction between cilins and seths guys the nurse should always clarify the prescription and always request a new medication now anaphylaxis occurs more with Penicillin than any other drug and since allergies can range from mild to severe guys the key point during a reaction write this down stop or hold the medication then assess the type of reaction and always listen to the lungs or osculate the lungs lastly epinephrine prepare to administer we're always assessing for the typ of reaction first Common on the uncle and exit exams we do this before calling the doctor doctor or hcp and before calling Pharmacy guys assessment always comes first and then intervention second now as far as Administration with cilins the key terms here are we take with food if GI is upset so nausea vomiting and diarrhea and we shake well before using it always shaking it before we are taking it use a correct measuring device Doppler or oral syringe guys never a household spoon usually a common distractor there and lastly common side effects seths we usually get diarrhea but commonly antibiotics cause diarrhea anyways and cins big key word here is bleeding so we monitor the platelet count now for the big guns for the super bugs known for their very toxic effects killing the kidneys and the ears so we have two classes of drugs which kill the to kidneys and ears when they're toxic first is the glycopeptides class including Venom myosin which we can think is very toxic and we also have aminoglycoside class including toberin gasin and neamin now again both these guys end in mein so think it's myin to give a myosin since they're super toxic to the ear and kidneys and the main thing is to monitor the drug concentration in the blood again remember too high and the kidneys die and too low the infection grows so the key words to know for the exam is Peaks and troughs always checking 15 to 30 minutes before the next dose or before the next Administration guys we always draw and review the levels the range must be between 10 and 20 to be in therapeutic range again guys too high the kidneys will die so we always report and hold over 20 and we're reporting signs of toxicity ear damage known as autotoxicity so we're monitoring For Hearing and Balance changes again the enlex keyword here is vertigo or loss of balance and even a taxia the inability to walk and also tenius or ringing of the ears usually these are the first indications of kidney toxicity now speaking of of kidney damage nephrotoxicity mentioned over and over in many quiz Banks guys we're reporting and notifying the hcp of increasing bu and creatinine so creatinine over 1.3 means bad kidney and bu over 20 is definitely not good and lastly guys urine output 30 MLS per hour or less usually means the kidneys are in distress now spefic specific to Venom myosin given for very serious infections like MRSA and ciff in the gut Guys these bugs are hard to kill so venko is some pretty powerful stuff and consequently it burns during Administration so nursing considerations think venko burns the veins causing thrombophob bitis or venko is very irritating to tissues so it's usually given via pick line as preferred route so the key point is to assess the site every 30 minutes for pain redness and swelling guys make sure the IV is working and patent before Administration now the next big key term is Redman syndrome caused by rapid infusion now this is when we have a sudden onset of severe hypotension or low blood pressure flushing and parius basically itching and a big red rash on the face neck chest and extremities again it's not an allergic reaction so Red Man's is from a rapid infusion so simply slow the infusion so once again the key words is monitor blood pressure guys that's the biggest priority and Infuse slowly at least over 60 Minutes remember fast infusion means flushing now the enlex wants you to be a safe nurse and once you know the difference between the common red man syndrome and the deadly anaphylactic allergic reaction so guys the key words to look for for anaphylaxis is write these down hives angioedema and wheezing guys any respiratory distress or sign and symptom guys this is not red man syndrome this is a very serious allergy so immediately stop the infusion and administer epinephrine so remember the acronym Epi for when to administer epinephrine e for edema or angio edema P for for parius and hives and I for inspiratory and expiratory wheezes now lastly don't get tricked on the enx Venom myosin does not affect magnesium levels so there's no effect on mental status or dtrs this is usually magnesium and there's no effect on nausea vomiting like most antibiotics so there's no need for anti- nauseum meds now as far as aminoglycosides the indication is used to treat infections in Sy IC fibrosis and it's different than Mom myosin in that there's no red man syndrome and its mode of action is a little bit different in that it blocks the synthesis of bacteria to stop the bacterial growth but guys the enlex does not focus on this it rather focuses on ways that the drug can harm the patient so for toxic effects the key Point here is that it's very toxic in combination with bomin so ear toxicity as well as kidney toxicity AKA ototoxic and nephrotoxic you may need to stop the medication to prevent deafness so guys always notify the hcp of increasing bu and creatinine the key word here is increasing so you have to know your kidney numbers and guys we have an increased risk for toxic effects in the elderly populations as well as those with decreased renal function as well as when giving in high doses now a common distractor on most select all that apply questions is the normal effect of muscle aches and cramping now it's contraindicated in patients with neuromuscular diseases but for patients without the disease guys it's a normal finding so there's no need to report or notify and no need to stop the infusion this is a very common mistake most students make on exit exams as well as the enlex next up is macro Lids ending in thomasin like ziyin or a reasin guys yes it's true they sound a lot like our other meins but these are throw myosins not just mein so it's not too hard on the renals or ears but they're dangerous in their own way so the key points to write down here is prolonged QT intervals that could lead to cardiac arrest so we always monitor the ECG and report changes to the doctor or hcp so the memory trick is throw myosins they throw the ECG wave for prolonged QT intervals now they're also hepatotoxic or liver toxic so we monitor liver Labs the alts and a ests and Report increases to the hcp and guys be careful with the cam menine for fever during an infection Tylenol is very liver toxic now common side effects here so don't don't be tricked common test questions asks if you stop giving the medication during nausea and vomiting fever or decreasing wbc's guys nausea vomiting is common since it's taken on empty stomach fever is expected during an infection so we keep on giving and decreased wbc's means the infection is improving so don't be tricked next up is Tetra cyclings ending in cycling like doxic cycling now the key points for the exam is it's not pregnancy safe tooth discolorations as well as sunburns so we teach patients to wear sunscreen so the memory trick is thinking of a person that's cycling on a bike now cycling is dangerous so it's not safe for pregnant mothers you can get bugs in your teeth while cycling on a bike leading to tooth discoloration and use sunblock when out cycling around now the big indication is mainly used for skin acne and the mechanism of action is that it blocks protein synthesis to stop bacterial growth now for patient teaching the big key terms for the exam is number one use additional contraception guys accidental pregnancies are very common due to the decrease effectiveness of oral contraceptives number two is take on an empty stomach for best absorption not with food usually 1 to 2 hours before or after meals now third the biggest one here guys write this down sit up 30 minutes after taking do not lay down the pill induced esophagitis is really the biggest side effect we're talking bad bad heartburn that can lead to scarring of the esophagus guys that's very dangerous and number four always avoid calcium products which block absorption key words are no Dairy no anti acids and even no iron not technically Al a calcium product but we also avoid the iron next up is metrona Dazzle brand named flagel ending in Dazzle so the key points here is it's the number one drug used to treat seiff infection that Super Bug inside the gut now guys write this down the enlex will try and trick you with seph triaxone which actually causes CI now majority of students get confused and get this wrong now it also treats STI or tricomoniasis basically a sexually transmitted infection this term came up a few times in the Hess exit exams so think Dazzle in metrona Dazzle like there's nothing dazzling about ciff or STI now the next key points are to avoid eoh or alcohol both during and 3 days after the treatment now this was mentioned in several sections in both ATI and hessie guys patients will have violent vomiting and cramping if alcohol's consumed during or after treatment now the side effects that are normal and no need to report are number one dark urine or discoloration Brown and Rusty as well as metallic taste so just think Metro Dazzle has a metallic taste now the deadly side effects guys report please any new rash or skin peling this is likely Steven Johnson syndrome which is necrosis of the skin and mucous membranes so always teach patients to report these immediately now for the memory tricks we use Metro for metrona Dazzle M for metallic taste and dark urine now again this is normal e for E basically avoid the alcohol T4 it treats C in that STI tricomoniasis and R for rash and skin peling that is what we report and O is for o not dazzling because there's nothing dazzling about C or STI now for the three UTI medications first on the list is sulfonamide antibiotics or trimethine sulfa brand name is Baum now the mechanism action is it stops folic acid synthesis so for side effects and teaching the word sulfas is in the drug which makes it a sulfa drug so remember the acronym sulf s is for sunburn so we teach patients to use sunblock and avoid the sun U is for urine crystals and specific gravity that's high which means the body is dry since sulfas really dry out the body and create urine crystals AKA kidney stones we teach the patients to L love the water always drinking two to three per day and F folic acid we have to take daily now contraindications we have hyper sensitivity to sulfa drugs we always assess for allergies to sanoras like GoRide the oral antidiabetic drug and we saw that one big on the hessie exit exam so the two key points here is if you have a rash on a GoRide that's a potential allergy to sulfa drugs and second it's not pregnancy safe next is floro quinolones Leo and cypro flosin brand name is Levaquin given to pneumonia and UTI patients so the key Point here is to avoid sun or keyword direct sun exposure and also a for Achilles tendon rupture now that's a huge test tip right there guys write that down we teach patients to report new muscle pain and a big contraindication is tendonitis so remember trick is flasin we call fall oxyen since you can fall with an Achilles tear or flexxin since it hurts when you flex your calf now lastly nephrotoxicity is rare So guys don't get tricked here many students want to avoid flasin when creatinin BN is high so students get confused with flasin because it sounds very similar to mayin in bomin and gomin guys those are the antibiotics that kill the kidneys so be careful with those myin and not ficin now our last drug is not an antibiotic we have phol paradine our brand name is Pyridium it's a UTI analesa given for pain relief during that burning and irritation of the U so some instructors stress the Pyro in pyodine like a pyro fire since it's used to ease the fiery Burning Sensations of UTI and since it turns the body fluid red and orange like a fire so the key Point here guys write these down it's normal there's no need to report those red and orange urine and body fluids but we do report liver toxicity symptoms like yellow skin and Scalera this is known as jaundice now that was a big hessy question now since pyodine stains cleans the underwear and clothing and bedding we teach patients to wear sanitary pads and also wear glasses instead of contacts while taking this med and we also teach never stop antibiotic therapy not even when you're starting to feel better commonly patients feel better and then they stop taking their Med and think the infection is gone so when they stop taking their antibiotic guys this is a big no no always teach clients to finish the entire course of antibiotics now that is always on exams now some common enlex questions from our 10,000 question review first what is the best action for the nurse to take before administering amoxicillin to a patient with allergies to lefloxin and seph triaxone so guys the enlex wants you to follow nursing process always assessment of the patient first intervention second and then reassess so number one clarify the order with Pharmacy no guys we don't do this before assessment of the patient option two ask the patient about the type of reaction they had to seph triaxone yes guys this is the correct option because sefs and sillins have the cross sensitivity here AK allergies so the enlex wants you to do key term clarify or assess the Patient First in this case we're assessing the type of reaction now the deadly anaphylactic reaction involving respiratory issues is the thing that we're looking for there now option three notify the hcp of the allergy guys not before assessment we always assess first and option four we don't do administer meds no we don't do that question two which medication can cause yellow Scalera and Clay colored stools select all that apply now guys the big thing here is liver toxicity key term is jaundice so yellow Scalera of the eye or skin and even clay colored stools rosin and phenazone purine so guys those are the two ones that are most liver toxic all the other ones are not as liver toxic now question three a patient is in sepsis and prescribes several antibiotics during their Hospital stay what patient teaching should be included C exhibit of list of medications so guys levaxin and doxycycline both no sun exposure and cycling guys is not baby safe just think about cycling on a bike it's not safe for pregnant patients and Venom myin remember these are mayasins they kill my kidneys it's my sin to give am myosin so guys creatinine over 1.3 bad kidney urine output 30 MLS per hour or less means the kidneys are in distress and a ZR myin guys it throws those QT intervals and throws the liver out of whack so once we know that the options are easier so option one avoid direct sun exposure yes number two oral birth control is ineffective yes that's correct number three take until symptoms subside no guys a big thing with antibiotics here we take the entire medication finish it out or take the full course and no we do not stop when we're feeling better number four monitor QT intervals yes guys for that throw myosin that throws or prolongs those QT intervals how about number five supplement with vitamin B6 guys know that's usually for inh a TB medication and lastly number six monitor creatinine and bu definitely for Veno or any type of mein kidneys guys got to monitor those kidney Labs now watching for our full video and new quiz Bank click right up here to access your free trial and please consider subscribing to our YouTube channel last but not least a big thanks to our team of experts helping us make these great videos all right guys see you next time [Music]