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Alright 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 superbugs like C.
diff 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.
Childcare for sillins, like penicillin, and cycling, like doxycycline. Key words here for the NCLEX 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 azithromycin. T for tetracycline like toxicycline. And F for fluoroquinolones 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 for fluoroquinolones like levofloxacin.
T for tetracycline like doxycycline. 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 Bactrim. And other sulfa drugs are sulfonylureas like glyburide, the oral antidiabetic, and even diuretics like thiazides and loops.
These have sulfa derivatives. So some key words on the exam. They're 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, soup.
Super toxic to the kidneys and ears are the ones ending in myosin, like vancomycin, gentamycin, and neomycin. Guys, just think it's a sin to give a myosin, since they're super toxic. So cover your ears and your kidneys. So with myosin, 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 go. grow. So we always report signs and symptoms of toxicity. First things first, ear damage, aka ototoxicity.
Keywords for the NCLEX is vertigo or loss of balance, tinnitus or ringing in the ears, and for kidney damage is nephrotoxicity. Guys, we report immediately increasing BUN and creatinine, those two kidney labs. 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 NCLEX trick you. Guys, myosin are the most toxic antibiotics. Not thromyosin like azithromyosin.
And not floxacin like ciprofloxacin. Guys, yes, they end in sin too. but are not myosins.
So remember, myosins are the most harmful here. Now for broad-spectrum antibiotics are silins and sporins. Guys, the mechanism of action is that it weakens or destroys the bacterial cell wall, causing lysis or death.
So for penicillin, they end in silin, like amoxicillin or ampicillin, and even pepracillin and tazobactam, which is kind of the outlier there. Now cephalosporins start with ceph like cephalexin, brand name Keflex, and cephazolin, and even ceftriaxone, the brand name Rocephin. 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 Cephs can cause C.
diff, guys. They do not treat it. Now, this was a common test question on Hesse. and ATI asking for the treatment of C.
diff. No, no, no, guys. Cephs do not treat C.
diff. So the key point and memory trick here are the three Cs. C for cross-sensitivity or allergy to both Cephs and Cylins. Guys, the key point is checking the allergy before giving either.
Since these drugs are structurally and chemically similar, Cephs and psyllins, 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 cephs and psyllins. And 40% of students usually get that wrong on exams.
So common NCLEX terms are anaphylaxis reaction between psyllins and cephs. 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 auscultate the lungs. Lastly, epinephrine, prepare to administer.
We're always assessing for the type of reaction first. Common on the NCLEX 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 SILINs, 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. Cephs, we usually get diarrhea, but commonly antibiotics cause diarrhea anyways. And sillens, 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 glycopeptides class, including vancomycin, which we can think is very toxic. And we also have aminoglycoside class, including tobramycin, gentamicin, and neomycin.
Now again, Both these guys end in myosin, so think it's my sin 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 ototoxicity. So we're monitoring for hearing and balance changes.
Again, the NCLEX keywords here is vertigo, or loss of balance, and even ataxia, inability to walk. And also tinnitus, 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 vancomycin given for very serious infections like MRSA and C. diff in the gut.
Guys, these bugs are hard to kill. So vanco is some pretty powerful stuff. And consequently, it burns during administration. So nursing considerations. Think vanco burns the veins causing thrombophlebitis.
Or vanco is very irritating to tissues. So it's usually given via PICC line. as a 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 pruritus, 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 NCLEX wants you to be a safe nurse and wants you to know that 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 angioedema, p for pruritus and hives, and i for inspiratory and expiratory wheezes. Now lastly, don't get tricked on the NCLEX. Vancomycin 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 aminoglycosides, the indication is used to treat infections in cystic fibrosis. And it's different than vancomycin in that there's no Redman 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 NCLEX 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 vancomycin.
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 NCLEX. Next up is macrolids ending in thromyosin like azithromyosin or erythromyosin. Guys, yes, it's true. They sound a lot like our other myosins. But these are thromyosins, not just myosin.
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 ASTs, and report increases to the HCP.
And guys, be careful with acetaminophen 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 WBCs. Guys, nausea and vomiting is common since it's taken on an empty stomach. Fever is expected during an infection, so we keep on giving. And decreased WBCs means the infection's improving, so don't be tricked. Next up is tetracyclines ending in cycling like...
doxycycline. 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 you 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 one 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.
Keywords are no dairy, no antiacids, and even no iron. Not technically a calcium product, but we also avoid the iron. Next up is metronidazole, brand name Flagyl, ending in dazzle. So the key points here is it's the number one drug used to treat C. diff infection, that superbug inside the gut.
Now guys, write this down. The NCLEX will try and trick you with ceftriaxone, which actually causes C. diff. Now, majority of students get confused and get this wrong.
Now, it also treats STI or trichomoniasis, basically a sexually transmitted infection. This term came up a few times in the HESI exit exams. So think dazzle and metronidazzle like there's nothing dazzling about C.
diff or STIs. Now, the next key points are to avoid ETOH or alcohol both during and three days. after the treatment. Now this was mentioned in several sections in both ATI and HESI.
Guys, patients will have violent vomiting and cramping if alcohol is 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 metrodazzle has a metallic taste. Now the deadly side effects guys, report please. Any new rash or skin pilling.
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 metronidazole, M for metallic taste and dark urine.
Now again, this is normal. E for ETOH, basically avoid the alcohol. T for it treats C. diff and that STI, trichomoniasis. And R for rash and skin pilling.
That is what we report. And O is for O not dazzling because there's nothing dazzling about C. diff or STIs.
Now for the three UTI medications. First on the list is sulfonamide antibiotics or trimethoprine sulfa. Brand name is Bactrim. Now the mechanism of action is it stops folic acid synthesis. So for side effects in teaching, the word sulfa is in the drug, which makes it a sulfa drug.
So remember the acronym S.O.L.F. 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 2-3 liters per day. And F, folic acid, we have to take daily. Now contraindications, we have hypersensitivity to sulfa drugs, we always assess for allergies to sulfonylureas, like Glyburide, the oral anti-diabetic drug.
Now we saw that one big on the HESI exit exam. So the two key points here is if you have a rash on a Glyburide, that's a potential allergy to sulfa drugs. And second, it's not pregnancy safe.
Next is fluoroquinolones, levo and ciprofloxacin. 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 tendinitis.
So a memory trick is floxacin, we call falloxacin, since you can fall with an Achilles tear. Or flexacin, 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 floxacin when creatinine BUN is high. So students get confused with... Phyloxacin, because it sounds very similar to myosin and vancomycin and gentamicin. Guys, those are the antibiotics that kill the kidneys. So be careful with those myosins and not Phyloxacin.
Now our last drug is not an antibiotic. We have finazolpyridine. Our brand name is Pyridium.
It's a UTI analgesic given for pain relief during that burning and irritation of UTIs. So some instructors stress the pyro in pyrodine like a pyro fire, since it's used to ease the fiery burning sensations of UTIs, 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 sclera. This is known as jaundice. Now, that was a big HESI question.
Now, since pyridine stains 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'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 some common NCLEX 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 lefloxacin and ceftriaxone? So guys. The NCLEX 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 ceftriaxone. Yes guys, this is the correct option. Because cefs and sillins have the cross sensitivity here.
A.K.A. allergies. So the NCLEX 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 sclera and clay-colored stools? Select all that apply.
Now, guys, the big thing here is liver toxicity. Key term is jaundice. So yellow sclera of the eye or skin and even clay-colored stools. Rithromycin and phenazone pyridine. 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?
See exhibit of list of medications. So guys, levofloxacin 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 vancomycin. Remember, these are myosins. 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 azithromycin, 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 thromyosin that throws or prolongs those QT intervals.
How about number five, supplement with vitamin B6. Guys, no, that's usually for INH, a TB medication. And lastly, number six, monitor creatinine and BUN.
Definitely for Venco or any type of myosin.