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hey guys nurse Mike here and welcome to
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simplenursing.com before we get today's
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lecture started please remember check
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rationals to test your knowledge join
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for free click the link in our
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description below all right guys let's
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begin now for the six top test tips for
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antibiotics guys write these down number
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one we always finish the med to prevent
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the super infection we want to prevent
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creating any super bugs like sea diff or
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MSA so guys the key words take until all
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the med is finished and do not stop
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taking when filling better guys always
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educate the patient to finish these meds
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number two is accidental pregnancy for
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cilins and cyclings so guys remember the
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three C's child care for cilins like
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penicillin and cycling like doxic
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cycling key words here for the enlex is
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oral contraceptives are ineective so we
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keyword use additional contraception
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like an IUD now test tip number three no
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alcohol guys antibiotics are hard on the
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liver and so is alcohol
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now test tip number four no food for MTF
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so just think move the food M for maids
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like aiom myosin t for tetracycline like
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toxic and F for floral quinolones like
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leof flaxin key words here take on an
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empty stomach with a full glass of
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water now number five is no sun so avoid
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fun in the Sun so remember
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FTS f for fluorquinolones like
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lolicin T for Tetra cycling like doxic
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cycling and a big one here is s for
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sulfa drugs just think s for
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sunburns a big drug here is trimethine
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sulfamethoxazol fancy words for the
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brand name
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Baum and other sulfa drugs are sulfuras
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like GoRide the oral an antidiabetic and
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even diuretics like thyoides and Loops
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these have sulfa derivatives so some key
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words on the exam their
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photosensitivity which means they're
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sensitive to light we always avoid
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direct sun exposure and guys a huge risk
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for sunburn so wear sun block and avoid
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the sun now lastly number six Super
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toxic to the kidneys and ears are the
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ones ending in mein like ven sin gmias
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sin and neemias sin guys just think it's
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a sin to give a Maya sin since they're
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super toxic so cover your ears and your
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kidneys so with masin the key points
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here guys write these down Peaks and
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troughs if they're too high then the
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kidneys will die and guys if the troughs
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too low then the infection will grow so
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we always report signs and symptoms of
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toxicity first things first damage AKA
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autotoxicity keywords for the enlex is
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vertigo or loss of balance tenius or
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ringing in the ears and for kidney
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damage is
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nephrotoxicity guys we report
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immediately increasing bu and creatinine
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those two kidney Labs so creatinine over
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1.3 just means bad kidney and guys bu
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over 20 these numbers should not be
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increasing now last urine output 30 m
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mph or less usually means kidneys are in
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distress now a little side note here
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don't let the enlex trick you guys mein
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are the most toxic antibiotics not throw
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mein like a zosin and not flosin like
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cypro flosin guys yes they end in sin
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too but are not myosin so remember
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mayasins are the most harmful here now
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for broadspectrum antibiotics are cilins
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and sporin guys the mechanism of action
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is that it weakens or destroys the
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bacterial cell wall causing Lis or death
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so for penicillin they end incin like
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amoxicillin or ampicilin and even pillin
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and tazobactum which is kind of the
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outlier there now seph Lorin start with
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seph like seph Xin brand named klex and
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seph fazolin and even seph triaxone the
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brand named rosean now both are
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considered pregnancy safe and
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breastfeeding safe but there are some
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specific differences for example
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penicillin causes accidental pregnancy
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since it bumps the pill again guys the
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key words here are oral contraceptives
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are ineffective and use additional
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contraceptive like a IUD and C for seths
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can cause sea diff guys they do not
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treat it now this was a common test
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question on hessie and ATI asking for
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the treatment of ciff no no no guys
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seths do not treat
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C so the key point and memory trick here
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are the three C's C for cross
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sensitivity or allergy to both seths and
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sillins guys the key point is checking
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the allergy before giving either since
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these drugs are structurally and
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chemically similar seps and cylin they
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can't be mixed and an allergy to one
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usually means an allergy to the other
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now you can mix nearly every other
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antibiotic except seths and cylind and
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40% of students usually get that wrong
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on exams so common en clix terms are
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anaphylaxis reaction between cilins and
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seths guys the nurse should always
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clarify the prescription and always
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request a new medication now anaphylaxis
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occurs more with Penicillin than any
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other drug and since allergies can range
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from mild to severe guys the key point
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during a reaction write this down stop
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or hold the medication then assess the
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type of reaction and always listen to
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the lungs or osculate the lungs lastly
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epinephrine prepare to
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administer we're always assessing for
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the typ of reaction first Common on the
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uncle and exit exams we do this before
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calling the doctor doctor or hcp and
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before calling Pharmacy guys assessment
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always comes first and then intervention
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second now as far as Administration with
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cilins the key terms here are we take
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with food if GI is upset so nausea
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vomiting and diarrhea and we shake well
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before using it always shaking it before
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we are taking it use a correct measuring
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device Doppler or oral syringe guys
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never a household spoon usually a common
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distractor there and lastly common side
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effects seths we usually get diarrhea
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but commonly antibiotics cause diarrhea
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anyways and cins big key word here is
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bleeding so we monitor the platelet
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count now for the big guns for the super
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bugs known for their very toxic effects
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killing the kidneys and the ears so we
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have two classes of drugs which kill the
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to kidneys and ears when they're toxic
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first is the glycopeptides class
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including Venom myosin which we can
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think is very toxic and we also have
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aminoglycoside class including toberin
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gasin and neamin now again both these
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guys end in mein so think it's myin to
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give a myosin since they're super toxic
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to the ear and
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kidneys and the main thing is to monitor
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the drug concentration in the blood
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again remember too high and the kidneys
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die and too low the infection grows so
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the key words to know for the exam is
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Peaks and troughs always checking 15 to
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30 minutes before the next dose or
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before the next
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Administration guys we always draw and
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review the levels the range must be
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between 10 and 20 to be in therapeutic
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range again guys too high the kidneys
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will die so we always report and hold
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over 20 and we're reporting signs of
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toxicity ear damage known as
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autotoxicity so we're monitoring For
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Hearing and Balance changes again the
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enlex keyword here is vertigo or loss of
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balance and even a taxia the inability
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to walk and also tenius or ringing of
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the ears usually these are the first
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indications of kidney toxicity now
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speaking of of kidney damage
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nephrotoxicity mentioned over and over
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in many quiz Banks guys we're reporting
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and notifying the hcp of increasing bu
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and creatinine so creatinine over 1.3
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means bad kidney and bu over 20 is
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definitely not good and lastly guys
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urine output 30 MLS per hour or less
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usually means the kidneys are in
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distress now spefic specific to Venom
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myosin given for very serious infections
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like MRSA and ciff in the gut Guys these
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bugs are hard to kill so venko is some
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pretty powerful stuff and consequently
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it burns during Administration so
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nursing considerations think venko burns
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the veins causing thrombophob
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bitis or venko is very irritating to
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tissues so it's usually given via pick
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line as preferred route
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so the key point is to assess the site
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every 30 minutes for pain redness and
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swelling guys make sure the IV is
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working and patent before Administration
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now the next big key term is Redman
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syndrome caused by rapid infusion now
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this is when we have a sudden onset of
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severe hypotension or low blood pressure
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flushing and parius basically itching
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and a big red rash on the face neck
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chest and extremities again it's not an
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allergic reaction so Red Man's is from a
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rapid infusion so simply slow the
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infusion so once again the key words is
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monitor blood pressure guys that's the
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biggest priority and Infuse slowly at
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least over 60 Minutes remember fast
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infusion means flushing now the enlex
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wants you to be a safe nurse and once
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you know the difference between the
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common red man syndrome and the deadly
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anaphylactic allergic reaction so guys
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the key words to look for for
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anaphylaxis is write these down hives
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angioedema and wheezing guys any
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respiratory distress or sign and symptom
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guys this is not red man syndrome this
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is a very serious allergy so immediately
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stop the infusion and administer
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epinephrine so remember the acronym Epi
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for when to administer epinephrine e for
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edema or angio edema P for for parius
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and hives and I for inspiratory and
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expiratory wheezes now lastly don't get
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tricked on the enx Venom myosin does not
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affect magnesium levels so there's no
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effect on mental status or dtrs this is
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usually magnesium and there's no effect
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on nausea vomiting like most antibiotics
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so there's no need for anti- nauseum
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meds now as far as aminoglycosides the
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indication is used to treat infections
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in Sy IC
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fibrosis and it's different than Mom
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myosin in that there's no red man
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syndrome and its mode of action is a
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little bit different in that it blocks
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the synthesis of bacteria to stop the
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bacterial growth but guys the enlex does
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not focus on this it rather focuses on
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ways that the drug can harm the patient
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so for toxic effects the key Point here
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is that it's very toxic in combination
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with bomin so ear toxicity as well as
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kidney toxicity AKA ototoxic and
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nephrotoxic you may need to stop the
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medication to prevent deafness so guys
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always notify the hcp of increasing bu
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and creatinine the key word here is
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increasing so you have to know your
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kidney numbers and guys we have an
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increased risk for toxic effects in the
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elderly populations as well as those
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with decreased renal function as well as
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when giving in high doses now a common
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distractor on most select all that apply
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questions is the normal effect of muscle
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aches and cramping now it's
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contraindicated in patients with
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neuromuscular diseases but for patients
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without the disease guys it's a normal
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finding so there's no need to report or
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notify and no need to stop the infusion
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this is a very common mistake most
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students make on exit exams as well as
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the enlex next up is macro Lids ending
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in thomasin like ziyin or a
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reasin guys yes it's true they sound a
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lot like our other meins but these are
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throw myosins not just mein so it's not
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too hard on the renals or ears but
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they're dangerous in their own way so
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the key points to write down here is
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prolonged QT
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intervals that could lead to cardiac
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arrest so we always monitor the ECG and
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report changes to the doctor or
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hcp so the memory trick is throw myosins
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they throw the ECG wave for prolonged QT
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intervals now they're also hepatotoxic
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or liver toxic so we monitor liver Labs
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the alts and a ests and Report increases
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to the hcp and guys be careful with the
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cam menine for fever during an infection
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Tylenol is very liver toxic now common
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side effects here so don't don't be
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tricked common test questions asks if
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you stop giving the medication during
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nausea and vomiting fever or decreasing
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wbc's guys nausea vomiting is common
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since it's taken on empty stomach fever
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is expected during an infection so we
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keep on giving and decreased wbc's means
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the infection is improving so don't be
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tricked next up is Tetra cyclings ending
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in cycling like doxic cycling now the
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key points for the exam is it's not
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pregnancy safe tooth discolorations as
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well as sunburns so we teach patients to
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wear sunscreen so the memory trick is
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thinking of a person that's cycling on a
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bike now cycling is dangerous so it's
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not safe for pregnant mothers you can
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get bugs in your teeth while cycling on
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a bike leading to tooth discoloration
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and use sunblock when out cycling around
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now the big indication is mainly used
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for skin acne and the mechanism of
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action is that it blocks protein
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synthesis to stop bacterial growth now
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for patient teaching the big key terms
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for the exam is number one use
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additional contraception guys accidental
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pregnancies are very common due to the
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decrease effectiveness of oral
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contraceptives number two is take on an
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empty stomach for best absorption not
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with food usually 1 to 2 hours before or
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after meals now third the biggest one
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here guys write this down sit up 30
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minutes after taking do not lay down the
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pill induced esophagitis is really the
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biggest side effect we're talking bad
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bad heartburn that can lead to scarring
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of the esophagus guys that's very
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dangerous and number four always avoid
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calcium products which block absorption
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key words are no Dairy no anti acids and
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even no iron not technically Al a
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calcium product but we also avoid the
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iron next up is metrona Dazzle brand
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named flagel ending in Dazzle so the key
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points here is it's the number one drug
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used to treat seiff infection that Super
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Bug inside the gut now guys write this
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down the enlex will try and trick you
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with seph triaxone which actually causes
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CI now majority of students get confused
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and get this wrong now it also treats
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STI or
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tricomoniasis basically a sexually
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transmitted infection this term came up
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a few times in the Hess exit exams so
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think Dazzle in metrona Dazzle like
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there's nothing dazzling about ciff or
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STI now the next key points are to avoid
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eoh or alcohol both during and 3 days
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after the treatment now this was
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mentioned in several sections in both
00:17:56
ATI and hessie guys patients will have
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violent vomiting and cramping if
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alcohol's consumed during or after
00:18:05
treatment now the side effects that are
00:18:07
normal and no need to report are number
00:18:10
one dark urine or discoloration Brown
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and Rusty as well as metallic taste so
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just think Metro Dazzle has a metallic
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taste now the deadly side effects guys
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report please any new rash or skin
00:18:27
peling this is likely Steven Johnson
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syndrome which is necrosis of the skin
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and mucous membranes so always teach
00:18:35
patients to report these
00:18:38
immediately now for the memory tricks we
00:18:40
use Metro for metrona Dazzle M for
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metallic taste and dark urine now again
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this is normal e for E basically avoid
00:18:50
the alcohol T4 it treats C in that STI
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tricomoniasis and R for rash and skin
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peling that is what we report and O is
00:19:02
for o not dazzling because there's
00:19:05
nothing dazzling about C or
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STI now for the three UTI medications
00:19:14
first on the list is sulfonamide
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antibiotics or trimethine sulfa brand
00:19:20
name is Baum now the mechanism action is
00:19:23
it stops folic acid synthesis so for
00:19:27
side effects and teaching the word
00:19:29
sulfas is in the drug which makes it a
00:19:31
sulfa drug so remember the acronym
00:19:35
sulf s is for sunburn so we teach
00:19:39
patients to use sunblock and avoid the
00:19:40
sun U is for urine crystals and specific
00:19:44
gravity that's high which means the body
00:19:46
is dry since sulfas really dry out the
00:19:49
body and create urine crystals AKA
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kidney stones we teach the patients to L
00:19:55
love the water always drinking two to
00:19:58
three per day and F folic acid we have
00:20:02
to take daily now contraindications we
00:20:06
have hyper sensitivity to sulfa drugs we
00:20:09
always assess for allergies to sanoras
00:20:12
like GoRide the oral antidiabetic drug
00:20:15
and we saw that one big on the hessie
00:20:17
exit exam so the two key points here is
00:20:20
if you have a rash on a GoRide that's a
00:20:23
potential allergy to sulfa drugs and
00:20:26
second it's not pregnancy safe next is
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floro quinolones Leo and cypro flosin
00:20:34
brand name is Levaquin given to
00:20:36
pneumonia and UTI patients so the key
00:20:39
Point here is to avoid sun or keyword
00:20:43
direct sun exposure and also a for
00:20:46
Achilles tendon rupture now that's a
00:20:49
huge test tip right there guys write
00:20:50
that down we teach patients to report
00:20:53
new muscle pain and a big
00:20:55
contraindication is tendonitis so
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remember trick is flasin we call fall
00:21:02
oxyen since you can fall with an
00:21:05
Achilles tear or
00:21:07
flexxin since it hurts when you flex
00:21:10
your calf now lastly nephrotoxicity is
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rare So guys don't get tricked here many
00:21:17
students want to avoid flasin when
00:21:20
creatinin BN is high so students get
00:21:23
confused with flasin because it sounds
00:21:26
very similar to mayin in
00:21:29
bomin and
00:21:31
gomin guys those are the antibiotics
00:21:33
that kill the kidneys so be careful with
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those myin and not
00:21:39
ficin now our last drug is not an
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antibiotic we have phol paradine our
00:21:44
brand name is Pyridium it's a UTI
00:21:47
analesa given for pain relief during
00:21:50
that burning and irritation of the U so
00:21:53
some instructors stress the Pyro in
00:21:56
pyodine like a pyro fire since it's used
00:22:00
to ease the fiery Burning Sensations of
00:22:02
UTI and since it turns the body fluid
00:22:05
red and orange like a fire so the key
00:22:08
Point here guys write these down it's
00:22:10
normal there's no need to report those
00:22:13
red and orange urine and body fluids but
00:22:16
we do report liver toxicity symptoms
00:22:19
like yellow skin and Scalera this is
00:22:22
known as jaundice now that was a big
00:22:25
hessy question now since pyodine stains
00:22:28
cleans the underwear and clothing and
00:22:30
bedding we teach patients to wear
00:22:32
sanitary pads and also wear glasses
00:22:35
instead of contacts while taking this
00:22:37
med and we also teach never stop
00:22:40
antibiotic therapy not even when you're
00:22:43
starting to feel better commonly
00:22:45
patients feel better and then they stop
00:22:47
taking their Med and think the infection
00:22:49
is gone so when they stop taking their
00:22:52
antibiotic guys this is a big no no
00:22:54
always teach clients to finish the
00:22:56
entire course of antibiotics
00:22:59
now that is always on
00:23:02
exams now some common enlex questions
00:23:05
from our 10,000 question review first
00:23:08
what is the best action for the nurse to
00:23:10
take before administering amoxicillin to
00:23:13
a patient with allergies to lefloxin and
00:23:17
seph triaxone so guys the enlex wants
00:23:20
you to follow nursing process always
00:23:23
assessment of the patient first
00:23:25
intervention second and then reassess
00:23:29
so number one clarify the order with
00:23:31
Pharmacy no guys we don't do this before
00:23:34
assessment of the patient option two ask
00:23:37
the patient about the type of reaction
00:23:40
they had to seph triaxone yes guys this
00:23:42
is the correct option because sefs and
00:23:45
sillins have the cross sensitivity here
00:23:48
AK allergies so the enlex wants you to
00:23:51
do key term clarify or assess the
00:23:55
Patient First in this case we're
00:23:57
assessing the type of reaction now the
00:24:00
deadly anaphylactic reaction involving
00:24:03
respiratory issues is the thing that
00:24:04
we're looking for there now option three
00:24:07
notify the hcp of the allergy guys not
00:24:10
before assessment we always assess first
00:24:12
and option four we don't do administer
00:24:15
meds no we don't do that question two
00:24:17
which medication can cause yellow
00:24:19
Scalera and Clay colored stools select
00:24:22
all that apply now guys the big thing
00:24:25
here is liver toxicity key term is
00:24:28
jaundice so yellow Scalera of the eye or
00:24:31
skin and even clay colored stools rosin
00:24:35
and phenazone purine so guys those are
00:24:39
the two ones that are most liver toxic
00:24:41
all the other ones are not as liver
00:24:44
toxic now question three a patient is in
00:24:47
sepsis and prescribes several
00:24:49
antibiotics during their Hospital stay
00:24:52
what patient teaching should be included
00:24:54
C exhibit of list of medications so guys
00:24:58
levaxin and
00:25:00
doxycycline both no sun exposure and
00:25:04
cycling guys is not baby safe just think
00:25:06
about cycling on a bike it's not safe
00:25:09
for pregnant patients and Venom myin
00:25:12
remember these are mayasins they kill my
00:25:15
kidneys it's my sin to give am myosin so
00:25:19
guys creatinine over 1.3 bad kidney
00:25:23
urine output 30 MLS per hour or less
00:25:25
means the kidneys are in distress and a
00:25:28
ZR myin guys it throws those QT
00:25:32
intervals and throws the liver out of
00:25:34
whack so once we know that the options
00:25:37
are easier so option one avoid direct
00:25:40
sun exposure yes number two oral birth
00:25:43
control is ineffective yes that's
00:25:46
correct number three take until symptoms
00:25:50
subside no guys a big thing with
00:25:52
antibiotics here we take the entire
00:25:55
medication finish it out or take the
00:25:57
full course and no we do not stop when
00:26:00
we're feeling better number four monitor
00:26:03
QT intervals yes guys for that throw
00:26:06
myosin that throws or prolongs those QT
00:26:09
intervals how about number five
00:26:12
supplement with vitamin B6 guys know
00:26:15
that's usually for inh a TB medication
00:26:17
and lastly number six monitor creatinine
00:26:21
and bu definitely for Veno or any type
00:26:24
of mein kidneys guys got to monitor
00:26:27
those kidney Labs now watching for our
00:26:31
full video and new quiz Bank click right
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YouTube channel last but not least a big
00:26:40
thanks to our team of experts helping us
00:26:41
make these great videos all right guys
00:26:44
see you next time
00:26:49
[Music]
