What's up everyone? Welcome back.
It's Wednesday. I know we we missed one, but I
am here. I'm back, the team is back and
we are ready to rock. Today's going to be a lot of
fun. How's it going, everyone?
I see a lot of familiar faces. New course, old courses.
Welcome back to a great lecture. Today's going to be a lot of fun
because one, we're covering antibiotics, which I haven't
done before, and not only are we covering antibiotics, then we've
got trivia right after. So those that want to stick
around for trivia, I'm going to let you know right now.
Download Kahoot, download Kahoot.
It's an app. Download Kahoot and you'll be
able to just create a login real quick.
And then you'll be able to scan a barcode or put an enter a pin
and you'll be able to compete for prizes.
Today's lecture is going to be on again, on antibiotics.
I'm going to get into that real quick.
And then after that, we're going to do the trivia, which is to
get our neurons firing. You're going to see a lot of
associations happening real quick.
So, yeah, so real quick, let's get some announcements out of
the way. So again, financial assistance
letter, ask, ask, ask. I had no.
Times are tough and I understand groceries going up, gas is going
up, little things like milk are really, really expensive.
So ask for financial assistance. You'll be surprised how many
people are still willing to help you become a nurse.
Tutoring. Our tutoring is still on
special. I am sold out, so those of you
that already have me as a tutor can continue with me.
Those that don't, unfortunately I am sold out.
Free resources. Look, I've put up more podcasts
for putting up new YouTube videos.
We've put, we're posting more. We've got a great social media
team now that's going to be posting a lot of cool stuff.
So keep a lookout for it and just make sure that you're
following us on everything. Don't just follow it, subscribe
to it. So that way when I do put
something up, whether you're just a student using all the
free resources or you're actually a student that was in
old courses or in the current course, make sure that you
subscribe because sometimes I just throw up a podcast and you
were like, oh, whoa, Doctor Z forgot to tell us about this.
So again, make sure that you're following us on all the free
resources. There's nothing better than
free. So get your free education on
self paid paced course. Our next course is not going to
start till October 1st, October 1st.
We haven't finalized all the dates, but it does start October
1st. In the meantime, get started on
the self-paced course. Those that are in the course.
For those that have taken the on demand self-paced course, put
your honest feedback in the chat.
Like if you like it, if you don't like it, just be honest.
It's all I ask. Like yeah, it's not really worth
it or hey, I love it. Whatever you feel.
Just honesty is all we care about.
That is all our announcements for the most part.
Then something really bothersome happened and this really threw
me off. We found a bunch of people that
were sharing logins and that we're getting pirated and clicks
high yield videos a bunch. This is the letter that they are
going to receive. This is coming directly from my
lawyers at NCLEX High Yield. They told us straightforward
that they found people buying it on Facebook, people buying it on
Etsy, people sharing it. They were able to track Cash
App, Zelle, WhatsApp groups, Facebook groups.
They were they were able to find so many people and they were
able to track all their emails. If you received this e-mail, I
highly, I've been told you should find a lawyer.
If you get this e-mail, you should find your own
representation because they're coming after you hard.
So if you know anybody that's doing it or you are guilty of
it, then try to at least acknowledge it and come to some
sort of an agreement like, hey, we're not going to do it anymore
and they'll be forgiving. But this is happening as we
speak right now. So just that letter is going out
to everyone and you can take a screenshot of this if you want
so you can read and share it. So just it's sad to me that
people because they're getting reported, not only are they
getting sued, they're getting reported to all 50 States and
Canada, the boards. And right now ethics is huge,
huge because of all the schools that are being run unethically.
So please, please just don't do it.
Don't do it. It's not worth your livelihood
and your future. So I would just screenshot that.
If you know anybody that's doing it or a group that does it, just
screenshot it and share it on there like, hey, look, I would
stop doing this because they are coming after everyone.
So sorry about the bad news there not to be a Debbie Downer
flash sale is still going on 299 if you want to do that on
demand. So again, I I know all my
loyalty. I know I got a lot of people
that are loyal out there to end class high yield.
All the high yielders are definitely loyal.
And then we just been getting like, I'm not doing testimonials
anymore because I don't want to take up too much time in the
beginning, but these are messages that I'm getting in the
last like, look, September 2nd, Monday, it's just Wednesday.
These other ones came in today, 85 and out, 85 and out, 85 and
out. If you're doing something right.
And I see all like my, my students that are like keeping
their camera on their participating, they're answering
questions. You're in the right place,
you're in the right place. And if you're still struggling,
think about think about all the sorry, think about all the money
that you're losing every time that you're spending another
year, another year, another year, even 45 days.
So just make an investment. Doesn't have to be with us.
Just make an investment. All right, let's get started on
farm. So the cool thing about farm in
general, there's only five ways I can ask farm.
I write questions. I know exactly the five ways
that I'm going to ask you a farm question and that it should give
you some ease. It should give you a Peace of
Mind. Like, hey, look, if I see a
drug, there's really only five ways that they can ask me this
question. The first one is identification,
identify it, what type of a drug is this and what is it used for?
The second thing is what are the side effects of this drug?
The third one is contraindications.
If I take this drug, what can I not take or what should I not
take? Dosages maybe, maybe like there
are someones in EKG like adenosine, atropine, there are
some that we do administration and we do do dosages.
But for the most part, dosages are a little ambiguous unless
there's a strict protocol. So it's like, well, how much
atorvastatin should I start them on?
Well, it depends how bad was their cholesterol levels?
How are their liver function tests, so on and so forth.
So dosages aren't really super high yield.
The ones that are know that. And the other one, the last way
to ask it is just education what I'm going to teach you about
when it comes to medication. What am I going to educate you
if I discharge you? What am I going to educate you
about this medication when you consume it?
So there's only five ways. Those of you that have the quick
tip book, it's in the quick tip book, which are back in stock
and they're all shipped out. So I don't know if one of my
students has a link to it, that'd be great because I am
short staffed. So the this is the only ways
that I can ask a farm question. And if I'm asking you about
farm, then you should know you shouldn't memorize farm as an
entire subject. You should look at farm system
by system. Oh, this is a cardio drug.
Oh, this is a renal drug. Oh, this is heart failure.
Whatever the situation is, learn it that way so you can associate
it. You can associate it with that
specific, with that specific disease process, pathology, that
situation. So don't feel intimidated by
farm. For the most part, farm is going
to have a rhyme in a rhythm to the suffix or the prefix of the
actual drug. For instance, our Lol's or our
cyclins as we're going to learn today, our cillins as we're
going to learn today. There are ones that are not as
straightforward, things like mental health, like SSR is.
They don't have a complete rhyming rhythm to it.
But again, you definitely want to make that association.
For instance, in this quick tip, I talked about statins, I talked
about Nafils. So those drugs have that suffix.
So know them, identify them, and now you've made that
association. So now we get into antibiotics.
So the different classes of antibiotics are what I want you
to understand. I'm going to go with the highest
yield to the lowest yield. And so when I talk about them,
antibiotics are a little dry. They are a little dry, but I'm
going to highlight what you should know, period.
And then we are going to do practice questions before we get
into trivia today. So we're going to have a lot of
great information. Those of you that joined today,
you're in for a treat. You're really in for a treat.
So the first class of drug, arguably the most popular drug
that you're going to come across.
Now, let me preface this, this lecture by saying that
antibiotics are probably going to be the drug that you're going
to see the most. So think about that.
I talk about statins, I talk about beta blockers, I talk
about pills. I talk about all these drugs and
I'm like, look, they're commonly prescribed.
You should know them. What do you think is probably
one of the most commonly prescribed drugs, period?
Antibiotics, antibiotics, right? So people are going to get sick,
kids get sick, we get sick. So knowing your antibiotics,
whether you're taking them, prescribing them, or you're
seeing and educating your patients on them, you should be
familiar with them. And again, I'm going from the
highest yield to the lowest yield.
So our first one is penicillins. So penicillin G, penicillin V,
amoxicillin, ampicillin. Again, they all end in Sillin.
So what are they going to cover? Well, they're broad spectrum.
They're kind of our they are our first go to when a kid gets an
ear infection, when we see a kid with strep throat.
So think about where we start in Pediatrics.
We always start with penicillin or amoxicillin.
That little remember the pink bubble gum, the pink bubble gum
flavored one that we put in the fridge, right?
Everybody kind of remember that one.
So that's where we start. We start with penicillin.
But what we need to know, aside from the fact that it's a great
broad spectrum antibiotic, is that we can develop allergic
reactions. Now, when I was growing up,
penicillin allergies, not allergies, egg allergies, they
weren't a thing, OK. Nowadays, allergic reactions are
huge. They're huge so knowing that
penicillin does not only cause an allergic reaction, but they
can cause an anaphylactic anaphylactic sorry if stomach
lops anaphylactic reaction. The fact that they can cause
anaphylaxis means that it's life threatening.
Now, when we give a child its first dose of penicillin, any
type of penicillin, right, what are we going to see?
Are they going to like, is there airway going to close up?
Because that's what we're concerned about developing,
right? Is there airway going to close
up right away? Is that the first reaction
that's going to happen? Not necessarily what's going to
happen is welds or hives or itchy or swollen throat, but the
full blown anaphylaxis is when they have it a second time, when
they're exposed to it again and the body releases all this
histamine and the body releases this allergic anaphylactic
reaction because that is a deadly reaction.
So penicillin, again, the first line that we give as an
antibiotic and anaphylactics. So what are we looking for?
What we're looking for here is that they develop not just a
rash. A rash is not too indicative of
anaphylaxis, but when we have like a swollen throat, itchy
throat, welds, hives, now we're concerned it is metabolized by
the kidneys. So we're concerned about kidney
function, which means what lab values which you should know are
going to be part of the kidney BUN, creatinine, right?
And then a history of seizures. Now we move on to the second
most common one. And the reason why I put this as
the second most common tested 1 tested one is because
cephalosporins, they're also a great broad spectrum that can
cover a lot of different bugs. So things like respiratory
infections, you'll see, you'll see a skin infections.
But the problem with this is, is that it's got a cross reactivity
with penicillin, 10% cross reactivity, which means if
you're allergic to penicillins, then am I going to take a one in
10 chance that you're going to be OK with Cephalosporin knowing
that you can have an anaphylactic reaction?
Am I taking that chance? No, 10% is a lot. 1 in 10 people
can die. That's a high mortality rate in
my opinion, right, 10%. So what are we going to do?
We're going to educate. This is one of those questions
that are great education, educate your patient that hey,
oh, I'm the patient will say maybe a further teaching further
intervention for the education type of question.
I'm not allergic to cephalosporins.
I'm only allergic to penicillins.
Actually, we're going to teach you that cephalosporins have
cross reactivity. So if you're allergic to
anaphylactically, allergic to penicillins, we do not want to
give you any type of Cephalosporin.
So again, in general with these two drugs, I want you to take
away this. If I give you a medication, then
there is a chance that you're going to get some sort of GI
distress. Sometimes our stomach can't
handle it. And I always say with
medication, not all the time, but a good majority of the time,
what's the first reaction that we're going to see?
The first reaction will potentially see some sort of GI
distress, some nausea, vomiting, diarrhea.
So Gigi issues, But again, nothing that I'm too, too
concerned about more so we're worried about that.
Anaphylaxis, anaphylaxis. All right, now we move on to
macrolides. Macrolides erythromycin,
azithromycin, clarithromycin. The two that you're going to see
a lot, you're going to see erythromycin and you're going to
see azithromycin. With azithromycin, the big one
that I want you to know couple of one couple of things that I
want you to know, Upper respiratory bronchitis,
azithromycin, you're going to see azithromycin, also known as
AZ pack azithromycin. You're also going to see it in
sexually transmitted diseases. And we've had a surge of
sexually transmitted diseases. So do you think identifying
things like gonorrhea, chlamydia, syphilis is
important? Well, syphilis, you've got
penicillin, chlamydia, gonorrhea, we've got
azithromycin. These are things that are
surgery that are surging. So knowing St. is knowing the
treatment for it and now knowing this major side effects in this
one, the one that the boards are going to like to target is that
QT prolongation. So just a quick little, little
Segway into Ek GS. So we got our P wave and then we
got our QRST. The P wave is what part of the
heart. P is what part of the heart.
It is the atrium, which means that the QRST is what part of
the heart when the ventricle contracts.
So now if I've got QT prolongation, meaning this is
getting longer and longer and it's getting longer and longer,
what can happen to my ventricle? If I've got QT prolongation, I
can get a dysrhythmia. And that dysrhythmia that we're
concerned about is part of asgraph, right?
It is ventricular fibrillation. In this situation, we're worried
about the liver. So this is metabolized by the
liver. So, oh, I have the history of
SVT superventricular tachycardia.
I've had it a couple of times. Oh, OK, we are not giving you a
macrolide. So again, very important to
understand and identify these drugs.
And then we'll get into some practice questions here shortly.
The next one is tetracyclines. So what's the mnemonic that I
come up with with photosensitivity SAT for a
photo, right. So what, what drugs are there?
Sulfa drugs, which we're going to talk about as well too.
Then we've got amiodarone, which we talked about EKG's and now
we've got tetracycline sat for a photo, which means that one of
the biggest side effects that we're concerned about is
photosensitivity. So tetracycline, doxycycline
minus cycline are going to be. Used in this situation, most
commonly you'll see it in acne and acne we see a lot of
doxycycline being prescribed. So now you're talking about,
you're talking about maybe anybody from PEDs patient to to
an adult patient that's developed acne and now they've
got this prescription for doxycycline.
Well, depending on their age, we've got to be concerned about
pregnancy because it is a tridogen.
Then we've got to be worried about photosensitivity.
Some other ones that the boards like that aren't necessarily
something that's commonly seen is teeth discoloration, but they
like it. So now we're talking about
pregnancy photo sensitivity. So we educate them on what?
Wearing long sleeve clothes, wearing a hat, not going out in
the sun, avoiding the beach. We're worried about pregnancy.
So what type of a question that I just come up with?
I'm educating them. It's a select all that apply
100%. That's exactly how I would ask
it. And you know, if I say those
words, chances are you're probably going to see it like
that. So I'm going to educate them on
photosensitivity, GI disturbances, teeth
discoloration, pregnancy. Those are the ones that I'm
going to look at the most. And that's the way I'm going to
ask it. Or it's going to be a straight
up freebie question. Patient, let's just say a 16
year old patient. Oh, here's two questions.
OK, I'm making these up up the top of my head.
Here's two questions that I would ask for tetracycline.
So I write these down. A 16 year old female patient
comes in prescribed with acne vulgaris.
Which of the following drugs would be most appropriate?
Which would be most appropriate for the acne?
Straight up for a big question. And I'm probably going to put
doxycycline in there. I'll probably throw azithromycin
in there. I'll probably put a penicillin.
I'll put all these antibiotics in there and you're going to
have to say it's a tetracycline that I'm going to use.
That same patient, 16 year old female patient comes in and they
were, they were diagnosed with acne vulgaris.
And now we're saying which of the following is the most
appropriate action by the nurse? Well, what if I threw asked them
when their last cycle was when getting a UPT or urine pregnancy
test? Yeah.
Are they sexually active? If I put those into your answer
choices, I put it there for a reason, not necessarily always
the right one, but you better look at it a little bit closer.
Why did I put that in your answer choices?
So again, two questions that I would ask just like that.
And I know they're not in the practice question, so I wanted
to bring those up, but that's exactly how I would ask it.
It is a tradogen. It is a tradogen.
All right. Now the next ones are
fluoroquinolones and you'll see these now prescribed a lot.
They are commonly prescribed all these.
That's why I'm going in order ciprofloxacin, levofloxacin.
I apologize that to squeeze them in there and moxifloxacin,
right? So Levaquin, Cipro, these are
Avalox, these are the the brand names, but again, stick to the
generics, but they all end in floxacin.
They're really good for UTI's, respiratory infections and skin
infections. Those are kind of the ones that
I like that are going to be tested the most because when a
patient comes in with a UTI, how many people have seen
ciprofloxacin being prescribed a lot.
Is it the first line, though? It's not the first line.
That's where I'm going to get you.
There's two things I'm going to test you on ciprofloxacin.
And then what am I going to throw in there?
And we'll talk about this drug in a little bit.
It's trimethoprim, sulfamethoxazole, TMPSMX.
So when I put that in there, I'm going to put both in there.
And the first line for UTI is actually the trimethoprim
sulfamethoxazole, which is again Bactrim as the the brand name,
but it's great for you guys. The problem with this medication
is that we can develop a tendon rupture.
And what tendon are we concerned about that is debilitating if it
ruptures the Achilles, the Achilles.
Think about any sports player that has had an Achilles tendon
rupture and they're out for 891011 months, their season
ending. So yeah, sometimes they're that
debilitating that they don't even recover back from it to the
full ability. So again, that's the big one
that I want you to see along with the QT prolongation.
Those are the big ones. Moving on, the next one is
aminoglycosides. Aminoglycosides, this is your
gentamycin, tobramycin to amicacin.
But again, aside from the tobramycin, the mycin is spelled
differently. It's MICIN for gentamycin and
amicacin is just a CIN. So again, with this one, severe
infections, when do we use it? Which one do we use first?
It depends. Again, do we have allergic
reactions? Do we have any type of
sensitivity? Do you have any type of renal
impairment like we do here that we're concerned about?
So we're worried about things like autotoxicity and
nephrotoxicity, ototoxicity and nifrotoxicity.
And I'm highlighting the most important parts.
I know there's more in here, but I'm highlighting things that I'm
going to pick out for the boards, things that I would ask
you in a practice question. So we're looking at their renal
impairment. We're looking at their renal
function. The next one is sulfonamides.
So sulfa, methoxyzol, trimethoprim, sulfamethox,
methoxyzol. So TMPSMX this is this is
Bactrim, this is your first line for UTI.
This is your first line for UTI. Now the thing about sulfa drugs,
couple of things that we need to know again sat for a photo.
So photosensitivity big time. But with sulfa drugs now this is
an antibiotic that's a sulfa base.
We have other drugs that are sulfa base too.
Think about loop diuretics, think about thiazides, right?
Those are sulfa drugs. Think about sulfasalazine.
We talked about that in GI when we talked about inflammatory
bowel disease. So there are other drugs that
that have a sulfa base to it that are in different aspects of
medicine. This one is good for UT is, but
it's still a sulfa base. So we must ask them if they're
allergic to sulfa drugs and we must look out for SJS.
Anybody know what SJS stands for?
Steven Johnson syndrome? All sulfa drugs can cause Steven
Johnson's. What is Steven Johnson's and why
is it so dangerous? Why are we so concerned about
it? Like your body is going through
a a fire, your skin is sloughing off, which means you're losing
fluid, which means you're going to become septic, which means
that we're concerned about your skin.
We're concerned about this allergic reaction.
We're going to educate. If you see anything happening
with your skin, stop the drug immediately.
Stop the offending agent. It's one of those repetitive
things that I say stop the offending agent.
So again, we're looking at liver disease and then again, we're
worried about pregnancy here as well too.
So I've said that there are drugs that we're concerned about
with pregnancy. The mnemonic is Taratawa.
If you, if you're on our on any social media or if you have the
quick tip book, if you look in your notes, those that are my
that are my students, it's in there.
So it's going to be listed in there as well, too.
So look for identifying those drugs.
The next one is actually a great drug to test on and it's
vancomycin and we do IV vancomycin for MRSA, which is
what methicillin resistant staph aureus.
But the thing about IV vancomycin, I'm just talking IV
for MRSA, is that it can cause this transcutaneous flushing.
Transcutaneous. So all throughout my skin I'm
flushing and I look like it's called Redman syndrome because I
turn completely red. It's that transcutaneous
flushing. Is this anaphylaxis?
No, we're not freaking out about it.
Good. We're not freaking out about it
at all. In this situation, we're going
to do what? Slow down the infusion.
Slow down the infusion rate. Same thing with autotoxicity.
If this patient starts to complain of ringing of the ear
with vancomycin, if they start to complain of a fullness, then
you're going to slow down the infusion.
Slow down the infusion. This drug is metabolized by the
kidney. So we are very concerned about
their be on creatinine. Again, know the drugs
antibiotics wise that are metabolized by the liver that
are metabolized by the kidney. In general, if it's a high yield
drug, you should know which ones are metabolized by the liver
which metabolized by the kidney. Think about NSAIDs, kidney,
acetaminophen, liver. Why do we alternate those two in
pediatric patients? Because they're developing
organs. Why do you think we say give
them NSAID's first dose and give them acetaminophen the next dose
and alternate? We alternate because of the fact
that they've got developing organs.
Don't bombard 1 developing organ.
Now we move on to oral vancomycin.
Oral vancomycin. Now, if we've developed
Clostridium difficile or C diff and we are unable to attack it
by other drugs, we can resort to oral vancomycin.
Oral vancomycin is a great drug for C diff.
So those are the main takeaways for Vanco.
And the last one is the big guns.
OK, you will rarely see these ones, but if somebody's on them,
just know that we pulled out the big guns.
This is like setting off an atomic bomb in your in your body
of of medication. So imapenem, marapenem, these
are carbapenems and these are the ones that you'll see.
Typically you're going to see these in the hospital.
So you've got multi drug resistant infections.
Look at what I put. They're resistant to multiple
drugs. That's why they're called the
big guns. So you'll see them in places
like the ICU because they're being exposed to so many
different things. For instance, we've got the old
big gun, used to be Levaquin or levofloxacin.
Sorry, same thing, but I'm going back to generic levofloxacin.
But then we kept prescribing, kept prescribing, kept
prescribing. And guess what?
We started getting bacteria that was resistant to it.
So now the big gun that we had was no longer good.
That's why we're trying to avoid.
That's why I teach you try to figure out is this really a
bacterial infection or is this a viral infection?
And those that are my students know how to differentiate that
by looking at labs. We don't want to over medicate
or build up resistance. So these are the big guns, but
we're worried about seizures and super infection and again,
penicillin allergy and this one as well too.
So now we get into some practice questions.