hey guys nurse Mike here from simple nursing.com today we're tackling pharmarmacology with a focus on antibiotics and anti-infectives breaking down the big medications that you need to know for your exams oh and here's the best part we've got 28 study guides in the membership area one for each medication popping up in the top right corner as we go through them so be sure to grab those study guides and let's make sure this information sticks all right let's jump in 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 superbugs like Cadiff or MRSA so guys the key words take until all the med is finished and do not stop taking when feeling better guys always educate the patient to finish these meds number two is accidental pregnancy for sillins and cycling so guys remember the three C's child care for sillins like penicellin and cycling like doxycyc key words here for the enlex is oral contraceptives are ineffective so we key word 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 macrolids like a zithramyiain t for tetracycline like toxycycline and F for fuoquinolones like levoflaxin 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 are fuoricquinolones like levofluxin T for tetracycline like doxycyc and a big one here is S for sulfa drugs just think S for sunburns a big drug here is trimethoprin sulfamethoxazole fancy words for the brand name Bactrum and other sulfa drugs are sulfanoras like glyberide the oral antid-diabetic and even diuretics like thioides 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 sunblock and avoid the sun now lastly number six super toxic to the kidneys and ears are the ones ending in measin like venkcomyosin gentyosin and neamiasin guys just think it's a sin to give a myiain since they're super toxic so cover your ears and your kidneys so with myin 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 trough's too low then the infection will grow so we always report signs and symptoms of toxicity first things first ear damage aka odotoxicity keywords for the enclelex is vertigo or loss of balance tenitis or ringing in the ears and for kidney damage is nephrotoxicity guys we report immediately increasing BUN and creatinine those two kidney lamps so creatinine over 1.3 just means bad kidney and guys bun over 20 these numbers should not be increasing now lastly urine output 30 mls per hour or less usually means kidneys are in distress now a little side note here don't let the enclelex trick you guys are the most toxic antibiotics not thromyosin like a zithroyasin and not fluxin like cyproloxicane guys yes they end in sin 2 but are not measin so remember myasins are the most harmful here now for broadspectctrum antibiotics are sillins and sporins guys the mechanism of action is that it weakens or destroys the bacterial cell wall causing lis or death so for penicellin they end in sillin like amoxicylin or ampeoin and even pepillylin and tazobactum which is kind of the outlier there now sephosporins start with seph like sephylexin brand name klex and sephosolin and even sept trioxone the brand name rosephen now both are considered pregnancy safe and breastfeeding safe but there are some specific differences for example penicellin 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 sephs can cause seiff 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 Cadiff so the key point and memory trick here are the three C's c for cross sensitivity or allergy to both sephs and sillins guys the key point is checking the allergy before giving either since these drugs are structurally and chemically similar sepsin 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 sephs and sillins and 40% of students usually get that wrong on examins so common enclelex terms are anaphilaxis reaction between sillins and sephs guys the nurse should always clarify the prescription and always request a new medication now anaphilaxis occurs more with penicellin 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 oscultate the lungs lastly epinephrine prepare to administer we're always assessing for the type of reaction first common on the ENCLEX and exit exams we do this before calling the doctor or HCP and before calling pharmacy guys assessment always comes first and then intervention second now as far as administration with sillins 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 shaken it before we are taken 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 seth's we usually get diarrhea but commonly antibiotics cause diarrhea anyways and sillins big key word here is bleeding so we monitor the platelet count now for the big guns for the superbugs known for their very toxic effects killing the kidneys and the ears so we have two classes of drugs which kill the two kidneys and ears when they're toxic first is the glyopeptides class including venkcomyosin which we can think is very toxic and we also have aminoglycoside class including tobraosin genttoyoscin and neamyasin now again both these guys end in meosin so think it's myin to give a measin 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 otoxicity so we're monitoring for hearing and balance changes again the ENLEX keywords here is vertigo or loss of balance and even atexia the inability to walk and also tenitis or ringing of the ears usually these are the first indications of kidney toxicity now speaking of kidney damage nephrotoxicity mentioned over and over in many quiz banks guys we're reporting and notifying the HCP of increasing BUN and creatinine so creatinine over 1.3 means bad kidney and BUN 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 specific to venkcomyosin 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 thrombophilitis or venko is very irritating to tissues so it's usually given via pickline 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 red man syndrome caused by rapid infusion now this is when we have a sudden onset of severe hypotension or low blood pressure flushing and paritis 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 Enclelex 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 anaphilaxis is write these down hives angioadema and wheezing guys any respiratory distress or sin 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 epienephrine E for edema or angioadema P for paritis and hives and I for inspiratory and expiratory wheezes now lastly don't get tricked on the enclelex venkcomyiain 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-nausea meds now as far as amoglycosides the indication is used to treat infections in cystic fibrosis and it's different than venkcomyosin 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 enclelex 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 venkcomyosin 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 bun 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 enclelex next up is macrolids ending in thromyosin like a zithroyiain or arythrammyasin guys yes it's true they sound a lot like our other measins but these are thromyosins not just measin 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 throwasins they throw the ECG wave for prolonged QT intervals now they're also hpatotoxic or liver toxic so we monitor liver labs the ALTs and AS and report increases to the HCP and guys be careful with acetaminophene for fever during an infection tylenol is very liver toxic now common side effects here so 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 a infection so we keep on giving and decreased WBC's means the infection's improving so don't be tricked next up is tetracyc ending in cycling like doxycyc 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 decreased effectiveness of oral contraceptives number two is take on an empty stomach for best absorption not with food usually 1 to two 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 ant acids and even no iron not technically a calcium product but we also avoid the iron next up is Metronadazzle brand name flagagile ending in dazzle so the key points here is it's the number one drug used to treat cadiff infection that superbug inside the gut now guys write this down the enclelex will try and trick you with sept trioxone which actually causes cadiff now majority of students get confused and get this wrong now it also treats STI or tchamanasis basically a sexually transmitted infection this term came up a few times in the hess exit exams so think dazzle and metronadazzle like there's nothing dazzling about cadiff or STI now the next key points are to avoid ETOH 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 alcohols 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 pilling this is likely Stephven 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 metronadazzle m for metallic taste and dark urine now again this is normal e for eh basically avoid the alcohol t for it treats C diff and that STI tricomasis and R for rash and skin pilling that is what we report and O is for oh not dazzling because there's nothing dazzling about CIFF or STI now for the three UTI medications first on the list is sulphonomide antibiotics or trimethoprine sulfa brand name is Bactrum now the mechanism of action is it stops folic acid synthesis so for side effects and teaching the word sulfas 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 2 to three liters per day and folic acid we have to take daily now contraindications we have hyper sensitivity to sulfa drugs we always assess for allergies to sopanoras like glyboride the oral antid-diabetic drug and we saw that one big on the hessy exit exam so the two key points here is if you have a rash on a glyoride that's a potential allergy to sulfa drugs and second it's not pregnancy safe next is fluoricquinolones levo and cyproofluxin brand name is levoquin 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 contra indication is tendinitis so memory trick is flockin we call fall oxyin since you can fall with an Achilles tear or flexin 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 fluxin when creatinin b is high so students get confused with fluxin because it sounds very similar to measin and benkcomyosin and genttoyiacin guys those are the antibiotics that kill the kidneys so be careful with those meiains and not fuxin now our last drug is not an antibiotic we have phenol perodine our brand name is pydium it's a UTI analesic given for pain relief during that burning and irritation of the UTI so some instructors stress the pyro in pyrodine 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 pyroine stains the underwear and clothing and bedding we teach patients to wear sanitary pads and also wear glasses instead of contacts while taking this 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's 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 let's look at some top missed questions from our enclelex question bank created by the very people behind the enlex itself what is the best action for the nurse to take before administering amoxicylin to a patient with allergies to leflloxxicin and sept trioxone so guys the enclelex wants you to follow nursing process always assessment of the patient first intervention second and then reassessment 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 seep trioxone yes guys this is the correct option because sephs and sillins have the cross sensitivity here aka 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 rithroyiain and phenazone pyodine 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 prescribed several antibiotics during their hospital stay what patient teaching should be included see exhibit of list of medications so guys levofluxin 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 venkcommyasin remember these are myasins they kill my kidneys it's my sin to give a 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 zithroyiain 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 thromyasin 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 bun definitely for venkco or any type of measin kidneys guys got to monitor those kidney labs thanks for watching did you know you can unlock beautifully handcrafted study guides a packed with key points and memory tricks from all our videos plus you'll get access to over 1,200 exclusive videos not on YouTube all neatly organized by nursing school topic to make that complex nursing knowledge actually stick you'll also gain thousands of practice questions written by current professors and actual ENLEX writers so for access to all this and more click right up here or visit simple nursing.com and don't forget to 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