1 00:00:03,480 --> 00:00:06,080 What's up everyone? Welcome back. 2 00:00:06,440 --> 00:00:11,560 It's Wednesday. I know we we missed one, but I 3 00:00:11,560 --> 00:00:14,760 am here. I'm back, the team is back and 4 00:00:14,840 --> 00:00:16,680 we are ready to rock. Today's going to be a lot of 5 00:00:16,680 --> 00:00:18,080 fun. How's it going, everyone? 6 00:00:18,360 --> 00:00:21,520 I see a lot of familiar faces. New course, old courses. 7 00:00:21,760 --> 00:00:25,320 Welcome back to a great lecture. Today's going to be a lot of fun 8 00:00:25,320 --> 00:00:28,360 because one, we're covering antibiotics, which I haven't 9 00:00:28,360 --> 00:00:32,360 done before, and not only are we covering antibiotics, then we've 10 00:00:32,360 --> 00:00:35,200 got trivia right after. So those that want to stick 11 00:00:35,200 --> 00:00:37,440 around for trivia, I'm going to let you know right now. 12 00:00:37,440 --> 00:00:40,720 Download Kahoot, download Kahoot. 13 00:00:44,320 --> 00:00:48,400 It's an app. Download Kahoot and you'll be 14 00:00:48,400 --> 00:00:50,920 able to just create a login real quick. 15 00:00:51,320 --> 00:00:55,680 And then you'll be able to scan a barcode or put an enter a pin 16 00:00:55,680 --> 00:00:57,840 and you'll be able to compete for prizes. 17 00:00:58,720 --> 00:01:03,520 Today's lecture is going to be on again, on antibiotics. 18 00:01:03,800 --> 00:01:05,360 I'm going to get into that real quick. 19 00:01:05,720 --> 00:01:09,160 And then after that, we're going to do the trivia, which is to 20 00:01:09,160 --> 00:01:11,160 get our neurons firing. You're going to see a lot of 21 00:01:11,160 --> 00:01:13,480 associations happening real quick. 22 00:01:13,480 --> 00:01:16,760 So, yeah, so real quick, let's get some announcements out of 23 00:01:16,760 --> 00:01:20,560 the way. So again, financial assistance 24 00:01:20,560 --> 00:01:23,160 letter, ask, ask, ask. I had no. 25 00:01:23,440 --> 00:01:28,000 Times are tough and I understand groceries going up, gas is going 26 00:01:28,000 --> 00:01:31,240 up, little things like milk are really, really expensive. 27 00:01:31,720 --> 00:01:35,080 So ask for financial assistance. You'll be surprised how many 28 00:01:35,080 --> 00:01:38,280 people are still willing to help you become a nurse. 29 00:01:38,880 --> 00:01:40,520 Tutoring. Our tutoring is still on 30 00:01:40,520 --> 00:01:44,440 special. I am sold out, so those of you 31 00:01:44,440 --> 00:01:47,400 that already have me as a tutor can continue with me. 32 00:01:47,400 --> 00:01:49,640 Those that don't, unfortunately I am sold out. 33 00:01:50,760 --> 00:01:54,240 Free resources. Look, I've put up more podcasts 34 00:01:54,240 --> 00:01:57,640 for putting up new YouTube videos. 35 00:01:58,200 --> 00:02:02,000 We've put, we're posting more. We've got a great social media 36 00:02:02,000 --> 00:02:04,160 team now that's going to be posting a lot of cool stuff. 37 00:02:04,480 --> 00:02:06,880 So keep a lookout for it and just make sure that you're 38 00:02:06,880 --> 00:02:10,120 following us on everything. Don't just follow it, subscribe 39 00:02:10,120 --> 00:02:12,200 to it. So that way when I do put 40 00:02:12,200 --> 00:02:15,480 something up, whether you're just a student using all the 41 00:02:15,480 --> 00:02:18,160 free resources or you're actually a student that was in 42 00:02:18,160 --> 00:02:21,240 old courses or in the current course, make sure that you 43 00:02:21,240 --> 00:02:23,800 subscribe because sometimes I just throw up a podcast and you 44 00:02:23,800 --> 00:02:26,360 were like, oh, whoa, Doctor Z forgot to tell us about this. 45 00:02:26,640 --> 00:02:29,640 So again, make sure that you're following us on all the free 46 00:02:29,640 --> 00:02:31,160 resources. There's nothing better than 47 00:02:31,160 --> 00:02:33,920 free. So get your free education on 48 00:02:34,640 --> 00:02:38,000 self paid paced course. Our next course is not going to 49 00:02:38,000 --> 00:02:40,840 start till October 1st, October 1st. 50 00:02:41,120 --> 00:02:43,960 We haven't finalized all the dates, but it does start October 51 00:02:43,960 --> 00:02:46,120 1st. In the meantime, get started on 52 00:02:46,120 --> 00:02:48,520 the self-paced course. Those that are in the course. 53 00:02:48,520 --> 00:02:51,920 For those that have taken the on demand self-paced course, put 54 00:02:51,920 --> 00:02:53,480 your honest feedback in the chat. 55 00:02:53,480 --> 00:02:56,600 Like if you like it, if you don't like it, just be honest. 56 00:02:56,600 --> 00:02:58,360 It's all I ask. Like yeah, it's not really worth 57 00:02:58,360 --> 00:03:01,400 it or hey, I love it. Whatever you feel. 58 00:03:02,440 --> 00:03:04,680 Just honesty is all we care about. 59 00:03:06,040 --> 00:03:08,920 That is all our announcements for the most part. 60 00:03:09,680 --> 00:03:16,120 Then something really bothersome happened and this really threw 61 00:03:16,120 --> 00:03:20,960 me off. We found a bunch of people that 62 00:03:20,960 --> 00:03:24,960 were sharing logins and that we're getting pirated and clicks 63 00:03:24,960 --> 00:03:29,600 high yield videos a bunch. This is the letter that they are 64 00:03:29,600 --> 00:03:32,800 going to receive. This is coming directly from my 65 00:03:32,800 --> 00:03:38,800 lawyers at NCLEX High Yield. They told us straightforward 66 00:03:39,360 --> 00:03:43,600 that they found people buying it on Facebook, people buying it on 67 00:03:43,600 --> 00:03:47,080 Etsy, people sharing it. They were able to track Cash 68 00:03:47,120 --> 00:03:51,840 App, Zelle, WhatsApp groups, Facebook groups. 69 00:03:52,280 --> 00:03:55,920 They were they were able to find so many people and they were 70 00:03:55,920 --> 00:03:59,880 able to track all their emails. If you received this e-mail, I 71 00:03:59,880 --> 00:04:03,680 highly, I've been told you should find a lawyer. 72 00:04:04,120 --> 00:04:07,200 If you get this e-mail, you should find your own 73 00:04:07,200 --> 00:04:10,120 representation because they're coming after you hard. 74 00:04:10,400 --> 00:04:13,440 So if you know anybody that's doing it or you are guilty of 75 00:04:13,440 --> 00:04:18,560 it, then try to at least acknowledge it and come to some 76 00:04:18,560 --> 00:04:20,880 sort of an agreement like, hey, we're not going to do it anymore 77 00:04:21,279 --> 00:04:25,000 and they'll be forgiving. But this is happening as we 78 00:04:25,000 --> 00:04:29,400 speak right now. So just that letter is going out 79 00:04:29,400 --> 00:04:32,600 to everyone and you can take a screenshot of this if you want 80 00:04:32,600 --> 00:04:37,160 so you can read and share it. So just it's sad to me that 81 00:04:37,160 --> 00:04:39,960 people because they're getting reported, not only are they 82 00:04:39,960 --> 00:04:42,280 getting sued, they're getting reported to all 50 States and 83 00:04:42,280 --> 00:04:46,720 Canada, the boards. And right now ethics is huge, 84 00:04:46,840 --> 00:04:50,520 huge because of all the schools that are being run unethically. 85 00:04:50,880 --> 00:04:53,600 So please, please just don't do it. 86 00:04:53,600 --> 00:04:55,920 Don't do it. It's not worth your livelihood 87 00:04:55,920 --> 00:04:58,440 and your future. So I would just screenshot that. 88 00:04:58,440 --> 00:05:01,440 If you know anybody that's doing it or a group that does it, just 89 00:05:01,440 --> 00:05:03,520 screenshot it and share it on there like, hey, look, I would 90 00:05:03,520 --> 00:05:05,720 stop doing this because they are coming after everyone. 91 00:05:05,960 --> 00:05:09,080 So sorry about the bad news there not to be a Debbie Downer 92 00:05:10,160 --> 00:05:13,960 flash sale is still going on 299 if you want to do that on 93 00:05:13,960 --> 00:05:16,960 demand. So again, I I know all my 94 00:05:16,960 --> 00:05:18,680 loyalty. I know I got a lot of people 95 00:05:18,680 --> 00:05:20,320 that are loyal out there to end class high yield. 96 00:05:20,640 --> 00:05:22,560 All the high yielders are definitely loyal. 97 00:05:23,560 --> 00:05:27,440 And then we just been getting like, I'm not doing testimonials 98 00:05:27,440 --> 00:05:29,320 anymore because I don't want to take up too much time in the 99 00:05:29,320 --> 00:05:32,840 beginning, but these are messages that I'm getting in the 100 00:05:32,840 --> 00:05:36,200 last like, look, September 2nd, Monday, it's just Wednesday. 101 00:05:36,200 --> 00:05:40,960 These other ones came in today, 85 and out, 85 and out, 85 and 102 00:05:40,960 --> 00:05:43,560 out. If you're doing something right. 103 00:05:43,560 --> 00:05:46,720 And I see all like my, my students that are like keeping 104 00:05:46,720 --> 00:05:48,880 their camera on their participating, they're answering 105 00:05:48,880 --> 00:05:51,480 questions. You're in the right place, 106 00:05:51,480 --> 00:05:53,560 you're in the right place. And if you're still struggling, 107 00:05:53,920 --> 00:05:59,080 think about think about all the sorry, think about all the money 108 00:05:59,080 --> 00:06:01,800 that you're losing every time that you're spending another 109 00:06:01,800 --> 00:06:04,400 year, another year, another year, even 45 days. 110 00:06:04,760 --> 00:06:06,960 So just make an investment. Doesn't have to be with us. 111 00:06:07,040 --> 00:06:11,480 Just make an investment. All right, let's get started on 112 00:06:11,480 --> 00:06:16,360 farm. So the cool thing about farm in 113 00:06:16,360 --> 00:06:20,280 general, there's only five ways I can ask farm. 114 00:06:21,720 --> 00:06:26,440 I write questions. I know exactly the five ways 115 00:06:26,440 --> 00:06:34,240 that I'm going to ask you a farm question and that it should give 116 00:06:34,240 --> 00:06:36,160 you some ease. It should give you a Peace of 117 00:06:36,160 --> 00:06:38,160 Mind. Like, hey, look, if I see a 118 00:06:38,160 --> 00:06:40,360 drug, there's really only five ways that they can ask me this 119 00:06:40,360 --> 00:06:43,640 question. The first one is identification, 120 00:06:44,120 --> 00:06:48,240 identify it, what type of a drug is this and what is it used for? 121 00:06:49,320 --> 00:06:52,120 The second thing is what are the side effects of this drug? 122 00:06:53,960 --> 00:06:56,280 The third one is contraindications. 123 00:06:56,400 --> 00:06:59,960 If I take this drug, what can I not take or what should I not 124 00:06:59,960 --> 00:07:06,080 take? Dosages maybe, maybe like there 125 00:07:06,080 --> 00:07:09,840 are someones in EKG like adenosine, atropine, there are 126 00:07:09,840 --> 00:07:12,600 some that we do administration and we do do dosages. 127 00:07:13,000 --> 00:07:17,200 But for the most part, dosages are a little ambiguous unless 128 00:07:17,200 --> 00:07:21,080 there's a strict protocol. So it's like, well, how much 129 00:07:22,440 --> 00:07:24,200 atorvastatin should I start them on? 130 00:07:24,320 --> 00:07:27,120 Well, it depends how bad was their cholesterol levels? 131 00:07:27,320 --> 00:07:30,200 How are their liver function tests, so on and so forth. 132 00:07:30,200 --> 00:07:32,840 So dosages aren't really super high yield. 133 00:07:33,240 --> 00:07:38,120 The ones that are know that. And the other one, the last way 134 00:07:38,120 --> 00:07:42,040 to ask it is just education what I'm going to teach you about 135 00:07:42,040 --> 00:07:45,000 when it comes to medication. What am I going to educate you 136 00:07:45,000 --> 00:07:46,640 if I discharge you? What am I going to educate you 137 00:07:46,640 --> 00:07:49,040 about this medication when you consume it? 138 00:07:49,720 --> 00:07:52,520 So there's only five ways. Those of you that have the quick 139 00:07:52,520 --> 00:07:55,320 tip book, it's in the quick tip book, which are back in stock 140 00:07:55,320 --> 00:07:59,000 and they're all shipped out. So I don't know if one of my 141 00:07:59,000 --> 00:08:01,600 students has a link to it, that'd be great because I am 142 00:08:01,600 --> 00:08:08,520 short staffed. So the this is the only ways 143 00:08:09,200 --> 00:08:15,200 that I can ask a farm question. And if I'm asking you about 144 00:08:15,200 --> 00:08:21,480 farm, then you should know you shouldn't memorize farm as an 145 00:08:21,480 --> 00:08:25,560 entire subject. You should look at farm system 146 00:08:25,560 --> 00:08:27,880 by system. Oh, this is a cardio drug. 147 00:08:28,240 --> 00:08:32,559 Oh, this is a renal drug. Oh, this is heart failure. 148 00:08:32,600 --> 00:08:37,240 Whatever the situation is, learn it that way so you can associate 149 00:08:37,240 --> 00:08:41,000 it. You can associate it with that 150 00:08:41,000 --> 00:08:47,080 specific, with that specific disease process, pathology, that 151 00:08:47,080 --> 00:08:51,040 situation. So don't feel intimidated by 152 00:08:51,040 --> 00:08:54,720 farm. For the most part, farm is going 153 00:08:54,720 --> 00:09:00,280 to have a rhyme in a rhythm to the suffix or the prefix of the 154 00:09:00,280 --> 00:09:04,160 actual drug. For instance, our Lol's or our 155 00:09:04,160 --> 00:09:07,400 cyclins as we're going to learn today, our cillins as we're 156 00:09:07,400 --> 00:09:11,160 going to learn today. There are ones that are not as 157 00:09:11,640 --> 00:09:15,280 straightforward, things like mental health, like SSR is. 158 00:09:15,280 --> 00:09:18,360 They don't have a complete rhyming rhythm to it. 159 00:09:18,360 --> 00:09:21,520 But again, you definitely want to make that association. 160 00:09:21,880 --> 00:09:26,480 For instance, in this quick tip, I talked about statins, I talked 161 00:09:26,480 --> 00:09:29,960 about Nafils. So those drugs have that suffix. 162 00:09:30,320 --> 00:09:33,440 So know them, identify them, and now you've made that 163 00:09:33,440 --> 00:09:39,640 association. So now we get into antibiotics. 164 00:09:40,400 --> 00:09:45,200 So the different classes of antibiotics are what I want you 165 00:09:45,200 --> 00:09:49,360 to understand. I'm going to go with the highest 166 00:09:49,360 --> 00:09:55,040 yield to the lowest yield. And so when I talk about them, 167 00:09:56,600 --> 00:10:01,040 antibiotics are a little dry. They are a little dry, but I'm 168 00:10:01,040 --> 00:10:03,840 going to highlight what you should know, period. 169 00:10:04,200 --> 00:10:08,040 And then we are going to do practice questions before we get 170 00:10:08,040 --> 00:10:12,480 into trivia today. So we're going to have a lot of 171 00:10:12,480 --> 00:10:14,560 great information. Those of you that joined today, 172 00:10:14,760 --> 00:10:17,120 you're in for a treat. You're really in for a treat. 173 00:10:18,120 --> 00:10:21,760 So the first class of drug, arguably the most popular drug 174 00:10:21,760 --> 00:10:22,840 that you're going to come across. 175 00:10:23,200 --> 00:10:29,640 Now, let me preface this, this lecture by saying that 176 00:10:29,640 --> 00:10:35,400 antibiotics are probably going to be the drug that you're going 177 00:10:35,400 --> 00:10:39,520 to see the most. So think about that. 178 00:10:39,800 --> 00:10:44,880 I talk about statins, I talk about beta blockers, I talk 179 00:10:44,880 --> 00:10:46,320 about pills. I talk about all these drugs and 180 00:10:46,320 --> 00:10:47,760 I'm like, look, they're commonly prescribed. 181 00:10:48,200 --> 00:10:52,320 You should know them. What do you think is probably 182 00:10:52,320 --> 00:10:55,360 one of the most commonly prescribed drugs, period? 183 00:10:56,840 --> 00:11:02,640 Antibiotics, antibiotics, right? So people are going to get sick, 184 00:11:03,080 --> 00:11:07,320 kids get sick, we get sick. So knowing your antibiotics, 185 00:11:07,320 --> 00:11:10,240 whether you're taking them, prescribing them, or you're 186 00:11:10,240 --> 00:11:14,120 seeing and educating your patients on them, you should be 187 00:11:14,120 --> 00:11:16,280 familiar with them. And again, I'm going from the 188 00:11:16,280 --> 00:11:18,360 highest yield to the lowest yield. 189 00:11:19,000 --> 00:11:24,240 So our first one is penicillins. So penicillin G, penicillin V, 190 00:11:24,240 --> 00:11:27,560 amoxicillin, ampicillin. Again, they all end in Sillin. 191 00:11:28,240 --> 00:11:30,680 So what are they going to cover? Well, they're broad spectrum. 192 00:11:30,720 --> 00:11:34,520 They're kind of our they are our first go to when a kid gets an 193 00:11:34,520 --> 00:11:38,240 ear infection, when we see a kid with strep throat. 194 00:11:38,440 --> 00:11:41,480 So think about where we start in Pediatrics. 195 00:11:42,000 --> 00:11:45,560 We always start with penicillin or amoxicillin. 196 00:11:46,520 --> 00:11:51,480 That little remember the pink bubble gum, the pink bubble gum 197 00:11:51,480 --> 00:11:54,520 flavored one that we put in the fridge, right? 198 00:11:54,720 --> 00:11:56,240 Everybody kind of remember that one. 199 00:11:56,920 --> 00:12:00,400 So that's where we start. We start with penicillin. 200 00:12:01,560 --> 00:12:05,360 But what we need to know, aside from the fact that it's a great 201 00:12:05,360 --> 00:12:10,600 broad spectrum antibiotic, is that we can develop allergic 202 00:12:10,600 --> 00:12:14,720 reactions. Now, when I was growing up, 203 00:12:15,160 --> 00:12:17,480 penicillin allergies, not allergies, egg allergies, they 204 00:12:17,480 --> 00:12:21,720 weren't a thing, OK. Nowadays, allergic reactions are 205 00:12:21,720 --> 00:12:24,680 huge. They're huge so knowing that 206 00:12:24,680 --> 00:12:28,360 penicillin does not only cause an allergic reaction, but they 207 00:12:28,360 --> 00:12:38,420 can cause an anaphylactic anaphylactic sorry if stomach 208 00:12:38,420 --> 00:12:54,470 lops anaphylactic reaction. The fact that they can cause 209 00:12:54,470 --> 00:12:57,790 anaphylaxis means that it's life threatening. 210 00:12:58,390 --> 00:13:04,720 Now, when we give a child its first dose of penicillin, any 211 00:13:04,720 --> 00:13:07,920 type of penicillin, right, what are we going to see? 212 00:13:07,920 --> 00:13:09,920 Are they going to like, is there airway going to close up? 213 00:13:09,920 --> 00:13:11,640 Because that's what we're concerned about developing, 214 00:13:11,680 --> 00:13:13,400 right? Is there airway going to close 215 00:13:13,400 --> 00:13:15,920 up right away? Is that the first reaction 216 00:13:16,360 --> 00:13:20,840 that's going to happen? Not necessarily what's going to 217 00:13:20,840 --> 00:13:27,240 happen is welds or hives or itchy or swollen throat, but the 218 00:13:27,240 --> 00:13:32,680 full blown anaphylaxis is when they have it a second time, when 219 00:13:32,680 --> 00:13:36,560 they're exposed to it again and the body releases all this 220 00:13:36,560 --> 00:13:39,880 histamine and the body releases this allergic anaphylactic 221 00:13:39,880 --> 00:13:43,880 reaction because that is a deadly reaction. 222 00:13:43,880 --> 00:13:48,000 So penicillin, again, the first line that we give as an 223 00:13:48,000 --> 00:13:53,720 antibiotic and anaphylactics. So what are we looking for? 224 00:13:53,720 --> 00:13:58,880 What we're looking for here is that they develop not just a 225 00:13:58,880 --> 00:14:03,440 rash. A rash is not too indicative of 226 00:14:03,720 --> 00:14:08,320 anaphylaxis, but when we have like a swollen throat, itchy 227 00:14:08,320 --> 00:14:14,640 throat, welds, hives, now we're concerned it is metabolized by 228 00:14:14,640 --> 00:14:17,000 the kidneys. So we're concerned about kidney 229 00:14:17,000 --> 00:14:21,360 function, which means what lab values which you should know are 230 00:14:21,360 --> 00:14:27,520 going to be part of the kidney BUN, creatinine, right? 231 00:14:28,080 --> 00:14:39,040 And then a history of seizures. Now we move on to the second 232 00:14:40,320 --> 00:14:42,520 most common one. And the reason why I put this as 233 00:14:42,520 --> 00:14:46,120 the second most common tested 1 tested one is because 234 00:14:46,120 --> 00:14:51,040 cephalosporins, they're also a great broad spectrum that can 235 00:14:51,040 --> 00:14:54,920 cover a lot of different bugs. So things like respiratory 236 00:14:54,920 --> 00:14:58,720 infections, you'll see, you'll see a skin infections. 237 00:14:59,520 --> 00:15:04,760 But the problem with this is, is that it's got a cross reactivity 238 00:15:07,640 --> 00:15:13,800 with penicillin, 10% cross reactivity, which means if 239 00:15:13,800 --> 00:15:19,600 you're allergic to penicillins, then am I going to take a one in 240 00:15:19,600 --> 00:15:23,320 10 chance that you're going to be OK with Cephalosporin knowing 241 00:15:23,320 --> 00:15:25,320 that you can have an anaphylactic reaction? 242 00:15:25,800 --> 00:15:31,520 Am I taking that chance? No, 10% is a lot. 1 in 10 people 243 00:15:31,520 --> 00:15:34,680 can die. That's a high mortality rate in 244 00:15:34,680 --> 00:15:38,320 my opinion, right, 10%. So what are we going to do? 245 00:15:38,320 --> 00:15:40,680 We're going to educate. This is one of those questions 246 00:15:40,680 --> 00:15:45,080 that are great education, educate your patient that hey, 247 00:15:45,360 --> 00:15:48,560 oh, I'm the patient will say maybe a further teaching further 248 00:15:48,560 --> 00:15:50,560 intervention for the education type of question. 249 00:15:51,160 --> 00:15:52,600 I'm not allergic to cephalosporins. 250 00:15:52,600 --> 00:15:54,280 I'm only allergic to penicillins. 251 00:15:55,440 --> 00:15:59,760 Actually, we're going to teach you that cephalosporins have 252 00:15:59,760 --> 00:16:02,000 cross reactivity. So if you're allergic to 253 00:16:02,120 --> 00:16:05,080 anaphylactically, allergic to penicillins, we do not want to 254 00:16:05,080 --> 00:16:07,480 give you any type of Cephalosporin. 255 00:16:08,960 --> 00:16:13,360 So again, in general with these two drugs, I want you to take 256 00:16:13,360 --> 00:16:20,040 away this. If I give you a medication, then 257 00:16:20,120 --> 00:16:22,920 there is a chance that you're going to get some sort of GI 258 00:16:22,920 --> 00:16:25,080 distress. Sometimes our stomach can't 259 00:16:25,080 --> 00:16:26,880 handle it. And I always say with 260 00:16:26,880 --> 00:16:31,280 medication, not all the time, but a good majority of the time, 261 00:16:31,800 --> 00:16:34,040 what's the first reaction that we're going to see? 262 00:16:34,800 --> 00:16:37,600 The first reaction will potentially see some sort of GI 263 00:16:37,600 --> 00:16:40,120 distress, some nausea, vomiting, diarrhea. 264 00:16:40,600 --> 00:16:44,400 So Gigi issues, But again, nothing that I'm too, too 265 00:16:44,400 --> 00:16:47,120 concerned about more so we're worried about that. 266 00:16:47,400 --> 00:16:58,320 Anaphylaxis, anaphylaxis. All right, now we move on to 267 00:16:58,400 --> 00:17:02,560 macrolides. Macrolides erythromycin, 268 00:17:02,560 --> 00:17:04,960 azithromycin, clarithromycin. The two that you're going to see 269 00:17:04,960 --> 00:17:08,480 a lot, you're going to see erythromycin and you're going to 270 00:17:08,480 --> 00:17:12,319 see azithromycin. With azithromycin, the big one 271 00:17:12,319 --> 00:17:14,720 that I want you to know couple of one couple of things that I 272 00:17:14,720 --> 00:17:18,359 want you to know, Upper respiratory bronchitis, 273 00:17:19,400 --> 00:17:22,480 azithromycin, you're going to see azithromycin, also known as 274 00:17:22,640 --> 00:17:26,680 AZ pack azithromycin. You're also going to see it in 275 00:17:26,680 --> 00:17:31,320 sexually transmitted diseases. And we've had a surge of 276 00:17:31,960 --> 00:17:35,720 sexually transmitted diseases. So do you think identifying 277 00:17:35,720 --> 00:17:37,720 things like gonorrhea, chlamydia, syphilis is 278 00:17:37,720 --> 00:17:39,560 important? Well, syphilis, you've got 279 00:17:39,560 --> 00:17:42,800 penicillin, chlamydia, gonorrhea, we've got 280 00:17:42,880 --> 00:17:44,560 azithromycin. These are things that are 281 00:17:44,560 --> 00:17:50,840 surgery that are surging. So knowing St. is knowing the 282 00:17:50,840 --> 00:17:57,320 treatment for it and now knowing this major side effects in this 283 00:17:57,320 --> 00:18:02,120 one, the one that the boards are going to like to target is that 284 00:18:02,120 --> 00:18:11,000 QT prolongation. So just a quick little, little 285 00:18:11,000 --> 00:18:16,640 Segway into Ek GS. So we got our P wave and then we 286 00:18:16,640 --> 00:18:21,640 got our QRST. The P wave is what part of the 287 00:18:21,640 --> 00:18:26,640 heart. P is what part of the heart. 288 00:18:26,640 --> 00:18:33,680 It is the atrium, which means that the QRST is what part of 289 00:18:33,680 --> 00:18:38,720 the heart when the ventricle contracts. 290 00:18:39,680 --> 00:18:44,920 So now if I've got QT prolongation, meaning this is 291 00:18:44,920 --> 00:18:52,960 getting longer and longer and it's getting longer and longer, 292 00:18:53,680 --> 00:18:59,600 what can happen to my ventricle? If I've got QT prolongation, I 293 00:18:59,600 --> 00:19:03,560 can get a dysrhythmia. And that dysrhythmia that we're 294 00:19:03,560 --> 00:19:07,320 concerned about is part of asgraph, right? 295 00:19:07,520 --> 00:19:13,480 It is ventricular fibrillation. In this situation, we're worried 296 00:19:13,480 --> 00:19:17,520 about the liver. So this is metabolized by the 297 00:19:17,520 --> 00:19:20,440 liver. So, oh, I have the history of 298 00:19:22,360 --> 00:19:24,800 SVT superventricular tachycardia. 299 00:19:25,320 --> 00:19:29,240 I've had it a couple of times. Oh, OK, we are not giving you a 300 00:19:29,240 --> 00:19:35,200 macrolide. So again, very important to 301 00:19:35,200 --> 00:19:38,360 understand and identify these drugs. 302 00:19:38,360 --> 00:19:40,760 And then we'll get into some practice questions here shortly. 303 00:19:44,600 --> 00:19:48,920 The next one is tetracyclines. So what's the mnemonic that I 304 00:19:48,920 --> 00:19:54,080 come up with with photosensitivity SAT for a 305 00:19:54,080 --> 00:19:57,160 photo, right. So what, what drugs are there? 306 00:19:57,160 --> 00:19:59,560 Sulfa drugs, which we're going to talk about as well too. 307 00:20:00,440 --> 00:20:05,160 Then we've got amiodarone, which we talked about EKG's and now 308 00:20:05,160 --> 00:20:08,880 we've got tetracycline sat for a photo, which means that one of 309 00:20:08,880 --> 00:20:10,400 the biggest side effects that we're concerned about is 310 00:20:10,400 --> 00:20:15,160 photosensitivity. So tetracycline, doxycycline 311 00:20:15,520 --> 00:20:21,680 minus cycline are going to be. Used in this situation, most 312 00:20:21,680 --> 00:20:28,280 commonly you'll see it in acne and acne we see a lot of 313 00:20:28,280 --> 00:20:33,480 doxycycline being prescribed. So now you're talking about, 314 00:20:34,360 --> 00:20:40,800 you're talking about maybe anybody from PEDs patient to to 315 00:20:40,800 --> 00:20:45,400 an adult patient that's developed acne and now they've 316 00:20:45,400 --> 00:20:49,000 got this prescription for doxycycline. 317 00:20:50,000 --> 00:20:53,360 Well, depending on their age, we've got to be concerned about 318 00:20:53,680 --> 00:20:55,400 pregnancy because it is a tridogen. 319 00:20:57,600 --> 00:21:01,520 Then we've got to be worried about photosensitivity. 320 00:21:02,720 --> 00:21:05,920 Some other ones that the boards like that aren't necessarily 321 00:21:06,520 --> 00:21:11,120 something that's commonly seen is teeth discoloration, but they 322 00:21:11,120 --> 00:21:13,600 like it. So now we're talking about 323 00:21:13,600 --> 00:21:17,280 pregnancy photo sensitivity. So we educate them on what? 324 00:21:17,400 --> 00:21:20,400 Wearing long sleeve clothes, wearing a hat, not going out in 325 00:21:20,400 --> 00:21:25,560 the sun, avoiding the beach. We're worried about pregnancy. 326 00:21:27,000 --> 00:21:29,400 So what type of a question that I just come up with? 327 00:21:30,400 --> 00:21:33,480 I'm educating them. It's a select all that apply 328 00:21:33,880 --> 00:21:37,280 100%. That's exactly how I would ask 329 00:21:37,280 --> 00:21:38,520 it. And you know, if I say those 330 00:21:38,520 --> 00:21:40,920 words, chances are you're probably going to see it like 331 00:21:40,920 --> 00:21:43,880 that. So I'm going to educate them on 332 00:21:43,880 --> 00:21:46,840 photosensitivity, GI disturbances, teeth 333 00:21:46,840 --> 00:21:51,680 discoloration, pregnancy. Those are the ones that I'm 334 00:21:51,680 --> 00:21:55,000 going to look at the most. And that's the way I'm going to 335 00:21:55,000 --> 00:21:57,480 ask it. Or it's going to be a straight 336 00:21:57,480 --> 00:22:02,920 up freebie question. Patient, let's just say a 16 337 00:22:02,920 --> 00:22:05,040 year old patient. Oh, here's two questions. 338 00:22:05,360 --> 00:22:07,440 OK, I'm making these up up the top of my head. 339 00:22:07,920 --> 00:22:09,960 Here's two questions that I would ask for tetracycline. 340 00:22:09,960 --> 00:22:15,280 So I write these down. A 16 year old female patient 341 00:22:15,280 --> 00:22:18,840 comes in prescribed with acne vulgaris. 342 00:22:19,880 --> 00:22:24,640 Which of the following drugs would be most appropriate? 343 00:22:25,280 --> 00:22:27,600 Which would be most appropriate for the acne? 344 00:22:28,680 --> 00:22:31,960 Straight up for a big question. And I'm probably going to put 345 00:22:31,960 --> 00:22:34,640 doxycycline in there. I'll probably throw azithromycin 346 00:22:34,640 --> 00:22:35,960 in there. I'll probably put a penicillin. 347 00:22:36,280 --> 00:22:39,400 I'll put all these antibiotics in there and you're going to 348 00:22:39,400 --> 00:22:41,640 have to say it's a tetracycline that I'm going to use. 349 00:22:43,320 --> 00:22:49,520 That same patient, 16 year old female patient comes in and they 350 00:22:49,520 --> 00:22:52,760 were, they were diagnosed with acne vulgaris. 351 00:22:53,080 --> 00:22:56,880 And now we're saying which of the following is the most 352 00:22:56,880 --> 00:23:02,560 appropriate action by the nurse? Well, what if I threw asked them 353 00:23:02,560 --> 00:23:07,160 when their last cycle was when getting a UPT or urine pregnancy 354 00:23:07,160 --> 00:23:08,440 test? Yeah. 355 00:23:08,440 --> 00:23:11,960 Are they sexually active? If I put those into your answer 356 00:23:11,960 --> 00:23:16,800 choices, I put it there for a reason, not necessarily always 357 00:23:16,800 --> 00:23:20,080 the right one, but you better look at it a little bit closer. 358 00:23:20,360 --> 00:23:22,080 Why did I put that in your answer choices? 359 00:23:22,440 --> 00:23:27,360 So again, two questions that I would ask just like that. 360 00:23:27,400 --> 00:23:29,680 And I know they're not in the practice question, so I wanted 361 00:23:29,680 --> 00:23:32,360 to bring those up, but that's exactly how I would ask it. 362 00:23:37,640 --> 00:23:40,320 It is a tradogen. It is a tradogen. 363 00:23:42,560 --> 00:23:46,880 All right. Now the next ones are 364 00:23:46,880 --> 00:23:50,680 fluoroquinolones and you'll see these now prescribed a lot. 365 00:23:50,680 --> 00:23:52,520 They are commonly prescribed all these. 366 00:23:52,520 --> 00:23:56,120 That's why I'm going in order ciprofloxacin, levofloxacin. 367 00:23:56,200 --> 00:23:59,600 I apologize that to squeeze them in there and moxifloxacin, 368 00:23:59,600 --> 00:24:03,440 right? So Levaquin, Cipro, these are 369 00:24:04,080 --> 00:24:07,680 Avalox, these are the the brand names, but again, stick to the 370 00:24:07,680 --> 00:24:09,840 generics, but they all end in floxacin. 371 00:24:12,240 --> 00:24:18,800 They're really good for UTI's, respiratory infections and skin 372 00:24:18,800 --> 00:24:20,200 infections. Those are kind of the ones that 373 00:24:20,200 --> 00:24:24,960 I like that are going to be tested the most because when a 374 00:24:24,960 --> 00:24:28,760 patient comes in with a UTI, how many people have seen 375 00:24:28,760 --> 00:24:33,400 ciprofloxacin being prescribed a lot. 376 00:24:33,960 --> 00:24:39,160 Is it the first line, though? It's not the first line. 377 00:24:39,520 --> 00:24:41,040 That's where I'm going to get you. 378 00:24:41,200 --> 00:24:45,480 There's two things I'm going to test you on ciprofloxacin. 379 00:24:46,160 --> 00:24:47,520 And then what am I going to throw in there? 380 00:24:47,520 --> 00:24:49,200 And we'll talk about this drug in a little bit. 381 00:24:49,800 --> 00:24:54,440 It's trimethoprim, sulfamethoxazole, TMPSMX. 382 00:24:55,840 --> 00:24:59,280 So when I put that in there, I'm going to put both in there. 383 00:24:59,280 --> 00:25:01,600 And the first line for UTI is actually the trimethoprim 384 00:25:01,600 --> 00:25:06,920 sulfamethoxazole, which is again Bactrim as the the brand name, 385 00:25:08,800 --> 00:25:12,880 but it's great for you guys. The problem with this medication 386 00:25:12,880 --> 00:25:17,600 is that we can develop a tendon rupture. 387 00:25:19,760 --> 00:25:26,760 And what tendon are we concerned about that is debilitating if it 388 00:25:26,760 --> 00:25:31,040 ruptures the Achilles, the Achilles. 389 00:25:31,440 --> 00:25:35,920 Think about any sports player that has had an Achilles tendon 390 00:25:35,920 --> 00:25:41,880 rupture and they're out for 891011 months, their season 391 00:25:41,880 --> 00:25:45,360 ending. So yeah, sometimes they're that 392 00:25:45,360 --> 00:25:47,600 debilitating that they don't even recover back from it to the 393 00:25:47,600 --> 00:25:52,080 full ability. So again, that's the big one 394 00:25:52,080 --> 00:25:56,160 that I want you to see along with the QT prolongation. 395 00:25:58,720 --> 00:26:08,080 Those are the big ones. Moving on, the next one is 396 00:26:08,640 --> 00:26:12,600 aminoglycosides. Aminoglycosides, this is your 397 00:26:12,600 --> 00:26:14,920 gentamycin, tobramycin to amicacin. 398 00:26:15,440 --> 00:26:22,040 But again, aside from the tobramycin, the mycin is spelled 399 00:26:22,040 --> 00:26:26,600 differently. It's MICIN for gentamycin and 400 00:26:26,600 --> 00:26:32,720 amicacin is just a CIN. So again, with this one, severe 401 00:26:32,720 --> 00:26:36,120 infections, when do we use it? Which one do we use first? 402 00:26:36,600 --> 00:26:38,880 It depends. Again, do we have allergic 403 00:26:38,880 --> 00:26:40,440 reactions? Do we have any type of 404 00:26:40,440 --> 00:26:42,480 sensitivity? Do you have any type of renal 405 00:26:42,560 --> 00:26:45,280 impairment like we do here that we're concerned about? 406 00:26:45,720 --> 00:26:49,280 So we're worried about things like autotoxicity and 407 00:26:49,280 --> 00:26:53,840 nephrotoxicity, ototoxicity and nifrotoxicity. 408 00:26:53,840 --> 00:26:55,480 And I'm highlighting the most important parts. 409 00:26:55,640 --> 00:26:58,360 I know there's more in here, but I'm highlighting things that I'm 410 00:26:58,400 --> 00:27:01,320 going to pick out for the boards, things that I would ask 411 00:27:01,320 --> 00:27:06,280 you in a practice question. So we're looking at their renal 412 00:27:06,280 --> 00:27:08,960 impairment. We're looking at their renal 413 00:27:08,960 --> 00:27:18,190 function. The next one is sulfonamides. 414 00:27:19,030 --> 00:27:21,790 So sulfa, methoxyzol, trimethoprim, sulfamethox, 415 00:27:21,790 --> 00:27:26,800 methoxyzol. So TMPSMX this is this is 416 00:27:27,000 --> 00:27:30,520 Bactrim, this is your first line for UTI. 417 00:27:31,240 --> 00:27:35,440 This is your first line for UTI. Now the thing about sulfa drugs, 418 00:27:35,880 --> 00:27:38,600 couple of things that we need to know again sat for a photo. 419 00:27:39,640 --> 00:27:47,320 So photosensitivity big time. But with sulfa drugs now this is 420 00:27:47,320 --> 00:27:49,680 an antibiotic that's a sulfa base. 421 00:27:50,800 --> 00:27:52,880 We have other drugs that are sulfa base too. 422 00:27:53,040 --> 00:27:57,360 Think about loop diuretics, think about thiazides, right? 423 00:27:57,360 --> 00:28:00,480 Those are sulfa drugs. Think about sulfasalazine. 424 00:28:00,480 --> 00:28:03,840 We talked about that in GI when we talked about inflammatory 425 00:28:03,840 --> 00:28:06,920 bowel disease. So there are other drugs that 426 00:28:06,960 --> 00:28:12,120 that have a sulfa base to it that are in different aspects of 427 00:28:12,520 --> 00:28:16,800 medicine. This one is good for UT is, but 428 00:28:16,800 --> 00:28:20,520 it's still a sulfa base. So we must ask them if they're 429 00:28:20,520 --> 00:28:25,400 allergic to sulfa drugs and we must look out for SJS. 430 00:28:25,400 --> 00:28:27,520 Anybody know what SJS stands for? 431 00:28:30,320 --> 00:28:39,520 Steven Johnson syndrome? All sulfa drugs can cause Steven 432 00:28:39,520 --> 00:28:44,200 Johnson's. What is Steven Johnson's and why 433 00:28:44,200 --> 00:28:46,680 is it so dangerous? Why are we so concerned about 434 00:28:46,680 --> 00:28:49,640 it? Like your body is going through 435 00:28:49,680 --> 00:28:54,800 a a fire, your skin is sloughing off, which means you're losing 436 00:28:54,800 --> 00:28:57,880 fluid, which means you're going to become septic, which means 437 00:28:57,880 --> 00:29:01,320 that we're concerned about your skin. 438 00:29:01,520 --> 00:29:03,880 We're concerned about this allergic reaction. 439 00:29:03,880 --> 00:29:06,720 We're going to educate. If you see anything happening 440 00:29:06,720 --> 00:29:09,040 with your skin, stop the drug immediately. 441 00:29:09,040 --> 00:29:11,800 Stop the offending agent. It's one of those repetitive 442 00:29:11,800 --> 00:29:14,120 things that I say stop the offending agent. 443 00:29:16,320 --> 00:29:21,200 So again, we're looking at liver disease and then again, we're 444 00:29:21,200 --> 00:29:22,840 worried about pregnancy here as well too. 445 00:29:23,640 --> 00:29:28,160 So I've said that there are drugs that we're concerned about 446 00:29:28,160 --> 00:29:31,320 with pregnancy. The mnemonic is Taratawa. 447 00:29:31,440 --> 00:29:34,880 If you, if you're on our on any social media or if you have the 448 00:29:34,880 --> 00:29:38,000 quick tip book, if you look in your notes, those that are my 449 00:29:38,040 --> 00:29:39,440 that are my students, it's in there. 450 00:29:40,080 --> 00:29:42,160 So it's going to be listed in there as well, too. 451 00:29:42,160 --> 00:29:44,880 So look for identifying those drugs. 452 00:29:47,320 --> 00:29:56,320 The next one is actually a great drug to test on and it's 453 00:29:56,320 --> 00:30:03,760 vancomycin and we do IV vancomycin for MRSA, which is 454 00:30:03,760 --> 00:30:07,040 what methicillin resistant staph aureus. 455 00:30:09,280 --> 00:30:13,280 But the thing about IV vancomycin, I'm just talking IV 456 00:30:14,000 --> 00:30:21,000 for MRSA, is that it can cause this transcutaneous flushing. 457 00:30:22,080 --> 00:30:25,080 Transcutaneous. So all throughout my skin I'm 458 00:30:25,080 --> 00:30:29,160 flushing and I look like it's called Redman syndrome because I 459 00:30:29,160 --> 00:30:31,720 turn completely red. It's that transcutaneous 460 00:30:31,920 --> 00:30:35,680 flushing. Is this anaphylaxis? 461 00:30:37,280 --> 00:30:38,920 No, we're not freaking out about it. 462 00:30:38,920 --> 00:30:40,920 Good. We're not freaking out about it 463 00:30:40,920 --> 00:30:44,080 at all. In this situation, we're going 464 00:30:44,080 --> 00:30:48,360 to do what? Slow down the infusion. 465 00:30:49,000 --> 00:30:54,680 Slow down the infusion rate. Same thing with autotoxicity. 466 00:30:55,480 --> 00:30:59,520 If this patient starts to complain of ringing of the ear 467 00:30:59,960 --> 00:31:06,920 with vancomycin, if they start to complain of a fullness, then 468 00:31:06,920 --> 00:31:10,080 you're going to slow down the infusion. 469 00:31:10,680 --> 00:31:14,960 Slow down the infusion. This drug is metabolized by the 470 00:31:15,200 --> 00:31:17,920 kidney. So we are very concerned about 471 00:31:17,920 --> 00:31:22,680 their be on creatinine. Again, know the drugs 472 00:31:23,040 --> 00:31:26,920 antibiotics wise that are metabolized by the liver that 473 00:31:26,920 --> 00:31:31,080 are metabolized by the kidney. In general, if it's a high yield 474 00:31:31,080 --> 00:31:33,800 drug, you should know which ones are metabolized by the liver 475 00:31:33,800 --> 00:31:37,760 which metabolized by the kidney. Think about NSAIDs, kidney, 476 00:31:38,000 --> 00:31:42,360 acetaminophen, liver. Why do we alternate those two in 477 00:31:42,360 --> 00:31:45,320 pediatric patients? Because they're developing 478 00:31:45,320 --> 00:31:47,480 organs. Why do you think we say give 479 00:31:47,480 --> 00:31:51,400 them NSAID's first dose and give them acetaminophen the next dose 480 00:31:51,680 --> 00:31:55,080 and alternate? We alternate because of the fact 481 00:31:55,360 --> 00:31:56,680 that they've got developing organs. 482 00:31:56,680 --> 00:31:59,760 Don't bombard 1 developing organ. 483 00:32:01,080 --> 00:32:06,760 Now we move on to oral vancomycin. 484 00:32:07,440 --> 00:32:10,880 Oral vancomycin. Now, if we've developed 485 00:32:11,160 --> 00:32:18,320 Clostridium difficile or C diff and we are unable to attack it 486 00:32:18,480 --> 00:32:23,520 by other drugs, we can resort to oral vancomycin. 487 00:32:24,240 --> 00:32:27,480 Oral vancomycin is a great drug for C diff. 488 00:32:28,440 --> 00:32:33,080 So those are the main takeaways for Vanco. 489 00:32:34,040 --> 00:32:37,400 And the last one is the big guns. 490 00:32:38,040 --> 00:32:43,200 OK, you will rarely see these ones, but if somebody's on them, 491 00:32:43,760 --> 00:32:47,960 just know that we pulled out the big guns. 492 00:32:48,320 --> 00:32:51,440 This is like setting off an atomic bomb in your in your body 493 00:32:51,600 --> 00:32:56,560 of of medication. So imapenem, marapenem, these 494 00:32:56,560 --> 00:33:00,520 are carbapenems and these are the ones that you'll see. 495 00:33:01,360 --> 00:33:03,000 Typically you're going to see these in the hospital. 496 00:33:03,920 --> 00:33:07,160 So you've got multi drug resistant infections. 497 00:33:07,160 --> 00:33:09,280 Look at what I put. They're resistant to multiple 498 00:33:09,280 --> 00:33:11,040 drugs. That's why they're called the 499 00:33:11,040 --> 00:33:14,040 big guns. So you'll see them in places 500 00:33:14,040 --> 00:33:18,360 like the ICU because they're being exposed to so many 501 00:33:18,360 --> 00:33:22,600 different things. For instance, we've got the old 502 00:33:22,600 --> 00:33:25,760 big gun, used to be Levaquin or levofloxacin. 503 00:33:25,760 --> 00:33:29,800 Sorry, same thing, but I'm going back to generic levofloxacin. 504 00:33:29,800 --> 00:33:31,760 But then we kept prescribing, kept prescribing, kept 505 00:33:31,760 --> 00:33:32,800 prescribing. And guess what? 506 00:33:33,360 --> 00:33:35,960 We started getting bacteria that was resistant to it. 507 00:33:36,600 --> 00:33:39,840 So now the big gun that we had was no longer good. 508 00:33:40,200 --> 00:33:42,240 That's why we're trying to avoid. 509 00:33:42,480 --> 00:33:45,080 That's why I teach you try to figure out is this really a 510 00:33:45,080 --> 00:33:46,920 bacterial infection or is this a viral infection? 511 00:33:47,280 --> 00:33:49,200 And those that are my students know how to differentiate that 512 00:33:49,200 --> 00:33:53,120 by looking at labs. We don't want to over medicate 513 00:33:53,160 --> 00:34:00,720 or build up resistance. So these are the big guns, but 514 00:34:00,720 --> 00:34:03,880 we're worried about seizures and super infection and again, 515 00:34:03,880 --> 00:34:06,480 penicillin allergy and this one as well too. 516 00:34:08,480 --> 00:34:14,360 So now we get into some practice questions.