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NCLEX Antibiotic Pharmacology Class for Nurses

I am Jay and 'm from IPASS. And representing Ibis to give you a one hour free lecture about antibiotic ladder, antibiotic ladder, that's a pretty much an interesting topic. Right? It's not only about NCLEX, but it's also about your practice. If you're practicing in the hospital right now while preparing for your NCLEX this is very much applicable. All right. And you will have lots of takeaways considering which antibiotics you're going to get you're going to give for a patient having UTI or a patient having pneumonia or patient having wounds for example, considering cellulitis, those kinds of things. All right. And when I say I think I'm sharing my screen now when they say antibiotic ladder, what do you mean by ladder by the way, ladder means what ladder one step at a time. Alright, so one step at a time. So to explain it to you guys.

Why, why does it say like ladder or antibiotics agar practically speaking, and it's still happening nowadays, whenever you have goals, for example, and then you are given a very strong antibiotics, what do you expect? What do you expect antibiotic resistance, okay, because you're not following the ladder, you have to follow the law, you have to follow certain antibiotics for at least, you know, common infections, I mean, just a simple infections, not necessarily giving stronger antibiotics, that's why you develop your antibiotic resistance, okay? And microorganisms associated with your antibiotic resistance are really strong, okay? To think about it, it should be you can only see that in the hospitals. You can acquire it from the hospital. That's why it's called like, you know, hospital acquired infections. But nowadays, if you look at the situation nowadays, hospital acquired infections is defined technically as what an infection acquired in the hospital from the word itself, after being admitted 48 hours to 72 hours, or, you know, two to three days.

But nowadays, you see patients coming to the ER, having for example, MRSA. MRSA is one, you know, microorganisms that is, you know, associated with your antibiotic resistance, methicillin resistant, right. So, I mean, they come to the hospital just came into the hospital within a period of 24 hours, they already have the MRSA. So if you think about it, practically speaking, there's no such thing as hospital acquired infections because they already acquired it from the community. It's not anymore. hospital acquired infections, and that's because we are not following the antibiotic ladder. Okay. So I'm going to divide the, this drawing into two. Okay, I'm gonna draw a line in between. Are you ready? Are we good? So two lines here, I mean, two divisions here. I'm gonna put here, I'm gonna make it in blue, gram positive, and this is your gram negative. Okay, shout out. Hi, Mr. Sylvester. Hi, Mr. Crane. Thank you for coming today. And this is another free lecture for those who just came in. Anyway, this is gram positive and this issue of gram negative microorganisms or bacteria. Okay, so what are the most common gram positive microorganisms, right? What are the most common gram positive bacteria? For example, I'm going to give you streptococcus. Okay.

I'm going to also going to give you staphylococcus what else. I'm also going to give you Enterococcus. All right, into our caucus, bacteria, streptococcus, and I'm also gonna put it here your Clostridium difficile. Okay, your Clostridium difficile. Okay, we have strep staph, Enterococcus and see the fee. So where can you see your streptococcus? Pneumonia? respiratory infections? What about your staphylococcus? It's everywhere. Eva. Staphylococcus can be everywhere in your skin or respiratory it's everywhere. Okay, and talking about also your memory cell and resistant Staphylococcus aureus, it can be everywhere. Okay, stuffy Lococo. So these are the common gram positive microorganisms. On the other hand, we also have your gram negative, or give me some microorganisms that are gram negative bacteria in the microscope. For example, I'm going to give you an E. Coli.

Okay, I'm going to give you E. coli, what else? Your ESBL. Your ESBL is a hospital. A hospital acquired guide on microorganisms as well, including your word, your Klebsiella. Okay, are Klebsiella and the famous, of course pseudomonas, but here in the US, not much of Pseudomonas it's most like, more and more common is like your MRSA, your those kinds of things. ESBL close are the common ones here in the US have you encountered these kinds of you know, microorganisms in the hospital. I mean, not acquiring, you know, acquiring for yourself and not  It's not only about that, I mean from your patients, okay, so gram positive and gram negative as well. streptococcus four gram positive pneumonia, respiratory infections, Enterococcus, from the word itself in Darrow bowel infections. staphylococcus and as well as C difficile, Clostridium difficile, Clostridium difficile is it can cause colitis, it's another form of bowel infection as well. Okay.

This is also brought about by antibiotic resistance Okay. E coli gram negative E. coli is where can you find this? What  infection can you find this E coli? Can I see your answers here where can you find this E coli? UTI? Okay UTI where can you find your ESBL? It's everywhere. It could be what it could be coming from respiratory it could be coming from urine alright. ESBL means what extended spectrum beta lactamase? In other words resistant or beta lactamase kind of, you know, antibiotics Klebsiella  is the most common cause of your pneumonia as well in the hospital. So, in other words, hospital acquired pneumonia, can you follow? So the mourners is everywhere. It could be a respiratory, it could be a skin infection. It could be everywhere. It could be bowel, it could be anything else. Okay.

So these are the microorganisms that I'm talking about here. The gram positive and the gram negative bacteria. Okay, what's the baseline antibiotics? What's the baseline antibiotics? I'm gonna write here your penicillin. Okay. I'm gonna write here and penicillin. That's the basis, right? If you're talking about the ladder, one step at a time, one step at a time. In other words, you're going to start it at the very mildest antibiotics. I'm going to start here, in this drawing, we have gram negative on this corner, right? Okay, so here, amoxicillin. I'm just gonna do I need to write the whole thing I guess not amoxicillin and as well as your ampicillin, right, your ampicillin and your amoxicillin, your amoxicillin is in the form of Bo, or ampicillin is in the form of your IV. That's the very baseline. Right? Your amoxicillin if you look at it, amoxicillin, your ampicillin is towards the gram negative.

Okay, I wrote it on your gram negative. Okay. That means to say, you can give amoxicillin, for example, for example, for a patient have been UTI later on. I'm going to tell you the conditions, the infections and then we're going to choose what kind of antibiotics this patient can get. Okay? amoxicillin, ampicillin. These are the basic antibiotics that we're giving to our patients. Am I right? Okay. But nowadays, there's lots of microorganisms that are resistant to amoxicillin and ampicillin as well. That's why they added some form of a chemical which is what we call a short beta lactamase, okay. So, what makes them broad or which means to say in Beric, which covers gram negative and gram positive because of the beta lactamase? So, beta optimize I'm gonna add here your beta lactamase? Okay, your beta lactamase in what makes your amoxicillin again, very effective to your gram positive and gram negative because of your beta lactamase.

That's why you see your collabo Landeck acid Alright, so amoxicillin plus your global ionic acid It's basically your core Moxie club. Right? That's your brand name. Do you still do you see that in in the US as well? You also see that in the US your coat epoxy club. Do you see that in the Philippines? Yes. You see that in the Philippines as well. Okay. What about your ampicillin your ampicillin plus your soul Bapaume. That is your unison. Right brand name is unison. amoxicillin plus your clavulanic acid is called a Moxie club and your ampicillin plus one bacterium is basically your unison. This makes them broad. If you notice, your beta lactamase, it covers your gram positive and as well as your gram negative microorganisms. In other words, if your patient is having some form of an infection, because of streptococcus or staphylococcus, your amoxicillin, pleasure Graviola Nick acid, does that cover also these kinds of infection if you're having some form of pneumonia because of streptococcal infection? Yes. Okay. You can give that again, because it's imperative it means to say it covers gram negative and as well as your gram positive bacteria.

Okay. There is lots of, you know, micro organisms that are resistant Up to this beta lactamase to this Moxie club and at the same time, you're unison. That's why we have what we call this your work. What do you think is the next one to this? What do you think is the next level to your amoxicillin and as well as your ampicillin? Because like I said, there's lots of, you know, microorganisms that are very, very, very strong, resistant to this kind of, you know, antibiotics. Okay, what do you think is next? What do you think is the next of this ladder? Okay? They'd be bailed up work by paraxylene. So what's next for you? And what's next? We're bypassing I mean, what's the added solution to your piperacillin? Your PIP basil, right? So Piper azulene plus your tezo backbone. In other words, this is also a form of beta lab dummies. Okay. From the word itself. days, so bad term. So piperacillin plus your days of baptism in the form of your soul sin, or sometimes your brand name is Pip diesel. In the Philippines, I guess the brand name is I forgot about it already. I'm sorry. What's the brand name in the Philippines for your baby? Vaseline plus diesel? Batum.

What's the brand name there? Come on. I'm looking at your live, live comments. Your pace of uptime and your piperacillin in the form of your pesos in I guess it stays in your taste of sin. There you go. These are the brand names that are common in the Philippines. Oh, Viagra said I didn't know that. So basil sin there you go. So sin, which our hospital is using some hospitals? Are you using PIP days? Also? I'm not sure in UK, they're using PIP basil, I guess. And your data said, Of course, I don't care about the brand name. If you're talking about NCLEX. You think about generic name. Okay, it's very, very rare that the NCLEX is giving you brand names they usually give you in your questions. Generic means okay. So hypersaline is about time. Like I said, this is also a beta lactamase, which means to say it covers gram positive and it also covers your gram negative bacteria. So that's how strong your you know your sourcing is your pipette acid and base it back down low. Now if your patient comes in because of UTI at the same time, your pneumonia, so can you give the same for the patient? Can you give piperacillin plus your tasers baton to your patient? Yes, you can give because again, this covers gram positive and gram negative bacteria.

Okay. So we're learning here, right? If you're, if you're, you're you know what, you're bypassing your date of birth time is very effective to your work, very effective to your pseudo your Pseudomonas kind of bacteria. That so I sometimes it's called as an anti Pseudomonas antibiotics, very effective to your Pseudomonas. Okay. So, if your patient is resistant to this Sosin the patient is still having some fever, the patient is still clinically not improving with that kind of infection. So it means to say the patient is resistant to that. Antibiotics. Okay, what's the next for your piperacillin for your plus your days of baptism? What do you think is next? Okay? What do you think is next? We have your carbapenems. Okay, your carbapenems are next okay in a form of your mere opinion All right, in a form of your mere opinion. Okay. This is what we call also a CR astray Unum Okay, your Astra your name nowadays we have lots of s3 Unum, okay? So s3 You know, so we have to the carbapenems and as well as your s3 you know, your Australian lamb is very good for respiratory kind of infection.

I don't words this to hear respiratory which means to say it could be cause it could be because of your staphylococcus or streptococcus. All right, this is against gram positive and as well as your gram negative microorganisms or bacteria. Okay, again, let's review on your on your gram negative baseline is your amoxicillin plus your clavulanic acid, ampicillin and sulbactam as well, they are in Beric because they have beta lactamase, okay, which means to say it covers gram positive and as well as your gram negative. Okay, give it a stronger one. Okay, give it a stronger one, which is your piperacillin plus your taser bapta. A stronger one or a sick patient. In other words, the patient is septic, they don't come to the hospital without fever. They don't come to the hospital if they're not, you know if they're feeling well, right that means to say this patient is sick. All right, piperacillin tazobactam is with beta lactamase, that means to say it's a stronger antibiotics, which covers gram positive and as well as your gram negative. If your patient is too much sick and then you know it's not, it's not responding to your piperacillin brush your teeth will make you give that patient the highest form of this antibiotics on this side, beside of the illustration, your Australia now at the same time, you're carbapenem stronger antibiotics if your patient is still you know, sick not responding to any form of treatment.

Okay, so that means to say if you are familiar with your mere opinions, these are strong antibiotics, okay? And as triona as well. Alright, so stay in them, and your carbapenems aztreonam is very good for chronic long standing pulmonary infections. Okay, so this is on the other side of this, you know of this illustration. Let's take a look up on the other side, it's more on to the positive. It's more on to your gram, gram positive. Let's take a look. We have what we call azurin methicillin Okay, have you heard the word methicillin? Have you given a medication in a form of methicillin? It's also a penicillin base. By the way, have you heard this word? I mean, this medication methicillin actually, you don't give this in, you know, I mean, you cannot see that in the floor in the unit. They're only going to make use of that in the laboratory to see if the patient is resistant or not. Okay, so if the patient is sensitive to your, let's just put it blue. For a microorganism known as your methicillin sensitive Staphylococcus aureus, look at this, I put the stuff below corpus or use on your gram positive, okay? Because it's gram positive, obviously. So they, they use your methicillin as a medium.

Again, like I said, to determine if the microorganism is sensitive, or resistant. So there's two, it's either MSSA or methicillin sensitive Staphylococcus aureus, or the other one is your MRSA. Okay, so MRSA, let's move to that later, right? So your methicillin in the form of for example, we have what we call of your as weak as your nafcillin. Okay, your nafcillin. So nafcillin is effective to your work. Again, this is more onto your gram positive, okay? So nafcillin is effective to your methicillin sensitive Staphylococcus aureus, okay? But it's not to your methicillin sensitive, okay though, you know, nafcillin is an example of your, obviously, of your methicillin. Okay, there's also one, your oxacillin All right, your oxacillin and as well as your nafcillin dot Sicilian. Your dog Cicilline. I guess nowadays, we have nafcillin. And your dog Cicilline. I'm not sure about the oxacillin nowadays, but anyway, so those are methicillin ins that are given to a patient having a staph infection, for instance, wounds, non complicated wounds as long as it's not MRSA because like I said, MRSA is resistant to this baseline antibiotics, which means to say we need another antibiotics.

And, again, I'm going to put here your MRSA, which means to say this, Staphylococcus aureus is methicillin resistant, we need to give a stronger antibiotics. What is the drug of choice? This is a very common NCLEX question, drug of choice for a patient having MRSA and MRSA can happen to everywhere. skin infections, for instance, respiratory infections, it can be UTI or urine infections, it could be bowel infections as well or GI infections. So what's the drug of choice again? What's the drug of choice for your MRSA? Come on, guys, what's the drug of choice for you? MRSA will help your vancomycin Alright, the famous NCLEX stain is your vancomycin. I'm going to put emphasis on this one, okay? Your vancomycin is a drug of choice for your methicillin resistant Staphylococcus aureus, okay? But please, vancomycin A has a narrow therapeutic index. In other words, chances of getting toxicity is very high. Okay, this is the usual thing that they're going to ask you in your NCLEX. So you always have to check for the therapeutic levels.

All right? Again, like I said, it has a very narrow therapeutic index. In other words, chances of getting toxic is very high, and chances of getting toxic, which means to say, toxicity Which organ in your body that you can associate with toxicity. Come on. So, you know, they're gonna ask you about that always, it's a matter of safety guys, okay? It's a matter of, you know, safety of your patient. And, and Chris is always going to ask you about safety. All right? So toxicity. So you're going to check for the therapeutic levels, which is about 10 to 20. Okay. All right. And as well as check for your word, kidneys, very good. It's very nephrotoxic my sins, especially your vancomycin, so check for your bond and as well as your craniotomy, okay, your bond is about 10 to 20 as well and creatinine is about 0.5 to 1.5. Okay, so check for the kidney function, the ban and creatinine. Okay, how are you going to check it? Okay, of course, and I've worked at the same time check for the therapeutic levels. In other words, if the therapeutic levels is too much, I mean, it's too high.

That means to say it's becoming toxic, I mean, the levels are too high, too, you're really creating in that means to say it's very toxic to your kidneys. They're gonna adjust the dose, going back here to your indication. So your vancomycin is the drug of choice for your MRSA. If the patient is still sick, what do you expect you're going to give? Come on, those people that are working in the hospital? If your vancomycin is not working, the patient is still sick. The patient is still having fever. What are you going to give? Come on guys? What are you going to get? What are you expecting from the doctors to get? There you go so what's your answer? Any idea guys? Any idea? Your vancomycin is not effective anymore. It could be a form of your like I said, we have Enterococcus here. So we have V R E, vancomycin resistant Enterococcus. Okay. vancomycin resistant Enterococcus, it could be vancomycin resistant Staphylococcus aureus. So these are the strong micro organisms that I'm talking about, okay? They are even resistant to your vancomycin. They are even resistant to any forms of antibiotics. So you go higher, okay, in a form of linezolid.

Okay, in the form of linezolid, make it white, of course, in the form of your linezolid. The most common brand name to this is a box, okay? Is a box, this very expensive medication because it's a higher form of antibiotics, okay, for a higher form of microorganism. So can you be blamed easily for a patient having simple colds? Definitely, that patient will develop some form of antibiotic resistance, you know what I mean? linezolid. Okay, this is very good for respiratory kind of infection, respiratory kind of infection, those patients who are having hospital acquired pneumonia. linezolid is very effective. There's another one you're optimizing. All right, you're optimizing. Optimizing is a higher form of, they're two different things from your vancomycin. I guess your vancomycin is glycopeptide. And your daptomycin is some form of a LiPo something that type anyway, the optimizing is good for bacteremia Okay, in other words, it's spread out. All right, it's everywhere. For example, I'm going to tell you, what's the easiest, I mean, what's the condition that can easily cause bacteremia? So this is for bacteremia. Okay, so for bacteremia

Okay, daptomycin what are the infection infectious, you know, conditions that can easily cause bacteremia endocarditis, this is very good for endocarditis guys, and double die. This is also caused by one, staphylococcus infection, that's why it's in your gram positive, does that make sense? Okay. So, they are actually considered as you know, as a broad spectrum antibiotics. In other words, it can cover gram positive but it can also cover gram negative. However, they are more effective to your gram positive microorganisms, okay, they are more effective to that. So that's why I'm going to put it here on the you know, on your gram positive. vancomycin is not it's not broad spectrum. It's very good for MRSA. However, it doesn't cover your, you know, your E. coli, your pseudomonas, your ESB and MCL It's very good for staph infections, especially your methicillin resistant Staphylococcus aureus. All right, are we learning here? I'm going to stop here, antibiotic ladder, I'm not gonna, I'm not going to finish my lecture, guys, I still have some antibiotics to discuss, okay?

Like I said, it's a ladder, one step at a time, just like your NCLEX. Okay, you will have to learn many things in your NCLEX before you will achieve the passing you know, standards, all right. But you know, it's challenging. In order in order for you to surpass your challenges, guys, you always have to deal with it one step at a time. Here I go. Again, I'm giving some thoughts to you guys, one step at a time. And please don't stop until you will be proud to yourself. Take No, go then go. Please don't stop. Don't stop until you will be proud to yourself. That means to say you do it one step at a time, one day at a time, until you master you know the concepts and you'll be able to, you know, achieve this goal. Okay, that's one thing and that's one thing. You know, I can probably give you some words of wisdom as I go along. Let's go to your, to your, what's the cephalosporins? Yeah, I'm gonna write here. cephalosporins. Okay, I'm just gonna write SEF Alright, so cephalosporins still considering your gram positive and gram negative, I'm gonna put your, I'm gonna make it yellow, I guess, your third generation in the middle of your fourth generation.

And as well as your fifth generation cephalosporins. I'm going to put here your second generation and here is your first generation. That means to say that your first generation and your second generation are good for gram positive microorganisms. Okay, in a form of you're gonna make it right or yellow, still yellow. You're your basic cephalic seem right, your basic cephalic scene. Your I think your second generation is yours a few weeks, I'm just gonna write a few. Okay, and your third generation antibiotics, which is very common here, Sif Triax soul All right, so try UK zone. I'm gonna put emphasis in your strike zone as well. So, trial zone is very common. You know why? Because if you look at this year, it covers both gram positive and as well as your gram negative. Now if your patient is having UTI, for example, at the same time having pneumonia, so septra episode covers both unless if your patient has some form of another infection that makes him really sick. You can another antibiotics that's why you can see triazole as well as your associate or your hyperacidity super partner. Do you get that? So your fourth generation I guess we have your separate time or separate beam to make it yellow again, your sappy beam is a fourth generation these are just examples of your first second, third, fourth and fifth generation.

We also have your fifth generation and yourself Tyrolean okay, you're Parylene Are you learning here? Can I say yes, from there. Okay. So first generation cephalic seen as the most basic, it's more on to your I would say it's more on to your gram positive. And when you say your CPA exam the same way as your cephalexin your third generation in the form of your SIP triazole which is to both gram positive and gram negative. Now, if you look up, you look at your fourth generation, look at your fourth generation, your fourth generation is more on to your gram negative. Okay, it's more onto your gram negative this same way as with your scepters said thoroughly, it doesn't mean that they are fourth generation or fifth generation, it doesn't mean that it covers everything. Okay? It doesn't mean that it covers your gram positive and gram negative there are some microorganisms that are covered. But you know, it's more on to your word, it's more on to your gram positive. Shall I just put it this way, I'm going to make a bar something like this.

Alright, so your, your first generation and you're second generation, it's more on height. I like the word height. It's more on hyper your gram positive, I'll put your gram positive and it goes down in here and into your gram negative. So this is basically your gram negative. So the same way, vice versa to your fourth generation and your fifth generation. So it's more on to your gram positive sorry about the visuals. It's more on to your gram negative sorry, and lesser coverage to your gram positive. So what's the safest antibiotics here? You're safe triazole because again, balance covers what I'm looking like that same here. It covers gram positive and as well as your gram negative microorganisms. That's why it's given for a patient having UTI with E. Coli. Okay. And as well as your, you know, gram positive with pneumonia for instance. That makes sense. Okay. So this is your cephalosporins Okay, what about T your What's this if you're into baseball and you know this, this is your first base, this is your home base. And this is your second base and this is your third base. I'm talking about your fluoroquinolones All right, your fluoroquinolones what are the examples of your fluoroquinolones, those antibiotics with a suffix which flow? ciprofloxacin, for example.

All right, so Ciprofloxacin. There's a flow on it, you know in the middle ciprofloxacin, so that's one example. Right? And secondly, we also have your labor of Locsin in the form of your Levaquin levofloxacin. All right, and lastly, your moxifloxacin again there is Am I correct with the spelling? moxifloxacin. There you go. There is flow there is flow here. That's how you remember the fluoroquinolones first I'm not going to talk about the mechanism of action. That's already pharmacology guys. I'm just telling you, what's the coverage, you know of this? Antibiotics. Alright, look at your Ciprofloxacin here. I'm gonna write it's more on to your gram negative. Okay. This is more on to your gram negative, it means to say Ciprofloxacin is good for your UTI as well. What did they write here? E. Coli. All right, that's good for your UTI. Right because E coli is the most common cause of your, you know, most common cause of your UTI.

So it's good for your UTI because it's more than your gram negative. Okay, so this is your gram positive as well moxifloxacin for example, if your patient is having some form of a skin infection, your moxifloxacin is good. What's good about your moxifloxacin is that it's P O at the same time and I before him, okay, I live a Fluxus in for instance, also P O in an IV form. Ciprofloxacin is in the form of P O. Okay, if your patient is not toxic, not coming to the hospital and having UTI, you know, it's not sick, they can go home with Ciprofloxacin. Okay, so let's talk about that later in terms of you know, the common infections, just a quick, you know, overview or what are the common antibiotics given for a patient having this kind of infection, it's gonna be quick. You know, as long as we already presented this, you know, this illustration, and then you will know what kind of antibiotics to be given considering your gram positive and gram negative as well. Okay? And I'm gonna draw a person here. Okay, I'm gonna draw a person here, okay. So, this is related to your anaerobic microorganism. All right, if your patient is developing some form of anaerobic, anaerobic kind of infection, which is brought about by microorganisms that can live in an environment without oxygen, for example, I would say stuff, Staph infections or stuff, microorganisms can leave also on an oxygenated kind of environment.

Okay. On the other hand, the common word, the common C diff, all right, your C. difficile, Clostridium difficile, it's very common. It's a very common also question in your NCLEX. Okay. For example, your staff, your C diff, and as well as your E. Coli. These are the common ones that can live in an oxygenated kind of environment. Okay, what's this person doing here? Okay. If you have for example, this is Gi, all right, in your tummy, right? And as well as in your genital urinary, so D O T. Okay. If you have this GI and God kind of infection, let's say reproductive or gynecological kind of infection. metronidazole is the drug of choice for the antibiotic of choice. All right. So in other words, if your patient is having some form of bowel infection, okay. Most of the time, it's E. Coli. It's an aerobic. If you see your patient having some horrible infections ear infection. Do you mean you expect your doctor to give metronidazole in a form of your flat zeal okay in the form of flattery for example, if you have some gynecological infection, you expect your doctor to give metronidazole as well.

Okay? Other than that with your other than your let's make it blue sorry, other than your GI and your G  skin for example. Other than this sites other than this blue color here, you give your clindamycin Okay, your clindamycin Okay, to clean the mice in for example, if you have a pimple that's outside of your GI that's outside of your genital urinary, or that's outside of your you know, your Guinee green the myosin is good for what? pimples? Okay, staphylococcus, it can be because of your staphylococcus okay? I don't believe that it's caused by an E. coli or something else where can you find your E. Coli from your books? Alright, so when it's usually staphylococcus, okay, so you give clindamycin because staphylococcus can be an anaerobic kind of microorganism. What did they say? It's either metronidazole or your clindamycin are we learning so far? Okay, so let's take a look at this one. See, we have covered your penicillin, your cephalosporins you also covered your fluoroquinolones, your penicillin, or cephalosporin, recover your fluoroquinolones and as well as your what else antibiotics which are very specific to your and Iran you know, to your anaerobic kind of bacteria, for example, your stuff C Diff E. coli metronidazole.

Now, if your patient is having some form of C difficile, what's the drug of choice? C the PCL What did they tell you earlier? It can cause bowel infection right here look at this one your C difficile sometimes we call it as your colitis All right colitis All right. All right C Diff colitis we call them as your C Diff colitis, which is you know, colitis infection to your bowel related to see if it could be because you're getting lots of antibiotics. That means to say that you received it is an antibiotic resistance kind of microorganism, which means you can apply that to the hospital by getting too much antibiotics. Okay, your C Diff colitis? What's the fear? Is it gram negative or gram positive? Come on, guys. Let's see the gram positive gram negative. What did I put that here in your gram positive microorganism at the same time? It's an aerobic. Okay, so what's the drug of choice by then? If you're having seeds if you're metronidazole? Because it's just I mean, it's in your GI, it's a you know, colitis, okay? At the same time, can you give vancomycin to the patient? Yes or no? Can you give vancomycin for a patient having C Diff colitis? Metroid Vania? Yes, that's correct.

But my question is apart from your metronidazole, can you give some form of another antibiotics? Can you see them as well? Gram positive, can you give vancomycin to the patient? Yes. So for a vancomycin patient for a vancomycin patient, you can give metronidazole it's also an NCLEX thing guys metronidazole. At the same time, you can also give not in a form of IV because vancomycin can be in the form of P O as well. So just p o vancomycin, in the form of like a syrup, right? So vancomycin at the same time, your metronidazole, these are the drug of choices for your C Diff colitis. And of course, if you have like coli, they say we'll have some form of diarrhea. You know, because it's inflamed, you know, it can trigger some form of diarrhea. Okay, so it's gonna be like, you know, smelly, you can really know this is saved. Alright, so you may, you know, you may recommend to the doctor, it looks like C diff, May, I'm going to save some specimen and to confirm that this is really C Diff colitis. Okay. So let's move on to the common infections.

If you have community acquired pneumonia. Are you getting me here guys? We're almost done. No, not yet. community acquired pneumonia. community acquired pneumonia. So it's supposed to be when you say the community acquired pneumonia from the word itself. community acquired pneumonia. You acquired that from the community, not from the hospital. It's either hospital acquired or community acquired. community acquired is acquired outside the hospital. Okay. So community acquired pneumonia. So what do you expect this patient will get? Okay? These are non toxic patients, they can go home, right? What did they tell you? streptococcal for example, staphylococcus for instance, it can cause pneumonia as well, right? And community acquired pneumonia, it's mostly gram positive. Okay, so what they expect if you want to give P O. Well, this patient can  also take azithromycin. Let's add another antibiotics here. Your patient can take azithromycin can be in a form of IV NPO. If the patient is our patient, patient can go as if through Meissen pneumonia, which means to say the patient is already developing fever at the same time, some form of a cough it's most likely you know, not the real kind of pneumonia, which azithromycin can cover.

Okay. IV Systemizing, a main form of IV if the patient is an inpatient status, okay, so inpatient. So as a promising can be given to a patient who is outpatient ambulatory at the same time as an inpatient okay as an inpatient alright, that's your as a promising now if your patient is you can also give some form of moxifloxacin. What did they tell you? moxifloxacin is more on to your gram positive as well so it covers your pneumonia community acquired pneumonia, okay? So, moxifloxacin can be in the form of P O and as well as your IV, okay. So if the patient is outpatient, the same thing, you can be p o as well. But nowadays, what we normally give is your Systemizing instead of your moxifloxacin because they found it more effective than your moxifloxacin. Now, let's take a look at your Let's see your hospital acquired pneumonia. Okay, your hospital acquired pneumonia. Your hospital acquired pneumonia is basically coming from a strong microorganism.

Okay? A hospital acquired pneumonia can be in a form of for example Klebsiella we're gonna make it blue guys can be in a form of Klebsiella What did they tell you earlier Klebsiella is far is a strong you know, microorganisms in the hospital. Okay, because the housekeepers are not cleaning that much. I'm not blaming the housekeepers guys, I you know, I admire the job, like you know, these are really kind of job Nakula and I think I appreciate that we need to appreciate Tori Klebsiella  what else you can have MRSA, okay, causing pneumonia. You can have Pseudomonas. Alright, and everything else you can have ESBL okay, you can have ESBL as well. You can have streptococcal, the most common form of pneumonia as well. Okay, so ESBL Klebsiella MRSA pseudomonas, you can also have your let's say, for example, your vancomycin resistant staph aureus. Now, that means to say hospital acquired pneumonia, that means to say that your patient is toxic, your patient is septic, your patient is sick. Okay? So you need stronger antibiotics stronger than your moxifloxacin stronger and don't say promising stronger antibiotics.

They usually combine it, it's a combo All right. And you can give what most commonly you can give your so based on our illustration, what can you give that covers both? Going back to your community acquired pneumonia? Can you also give some anoxic Komaki? Club? Yes, why not? Your amoxicillin? Yeah, that can be okay. Plus, as long as with clavulanic acid, that's fine, because that covers both gram positive as well as your gram negative amoxicillin, plain amoxicillin. No, you should have grabbed colonic acid on your Moxie club, because it covers again gram positive, which is most commonly you know your streptococcal. Okay, so Moxie club. Okay, going back here and your hospital acquired pneumonia? Well, we usually give a C or piperacillin. All right, your piperacillin plus Tehsil bafta. Because again, it covers what covers gram positive and as well as your gram negative. Okay. Remember, it could be because of ESBL. Right? It could be because of Klebsiella which is gram negative.

All right, this is gram negative, it could be because of staph infection, which is gram negative, which means to say your hyperacidity invested, you know, your days about Culvers gram positive and gram negative, you're safe to that and it's a very strong anti Baltics, if you look up the ladder, it's almost at the top right. Okay? If your patient is for example is not responding to your piping Vaseline, what did they tell you? European? carbapenems? Okay. And your aztreonam because it covers, you know, it covers also your gram positive. And who knows it's because of your Klebsiella as well because your patient is, you know, on a ventilator. Okay? That's the reason why you're having your aspiration pneumonia. This the very reason. I mean, this is the microorganism that can be blamed if you have some form of pneumonia coming from a ventilator, your ventilator associated pneumonia. So where are we learning so far? So piperacillin? Can you add up on a different antibiotics?

Yes, you can add up vancomycin. All right, you can add up vancomycin, can you also, for example, your piperacillin plus Taser bottom, plus your sift dry up zone wine? Okay. Your zip tie up zone is a private zone is a cephalosporin. What did they tell you about seatrout zone, you both covers your gram positive and gram negative as well. Because again, considering these microorganisms, it's either gram positive and gram negative as well. Most common questions as well in your NCLEX you will always have to, you know, get the culture first, before starting the antibiotics. It's very simple. It's a very basic you know, knowledge. Before you start any antibiotics please get your culture in some hospitals and still not following those bury, you know basic instructions, I would just call it instructions, you know, basic concepts. Whenever you start antibiotics, make sure that you know you or you got your contract or maybe I'm talking about your blood cultures and talking about your sputum cultures. If your patient is having some respiratory infections, you get your urine culture as well before starting any antibiotics, okay? So for patient have been hospital acquired pneumonia, these are the things that you need to know they are sick, you can give stronger antibiotics. If your patient is not responding to these kinds of antibiotics.

Again, you can escalate linezolid look at this one, look at our, our illustration here. You can give that to my son, you can give in easily but between you know, talking about still your hospital acquired pneumonia, but between your daptomycin and your linezolid I'll go with your linezolid. Okay, because linezolid is more to your respiratory. Okay, now if you got your culture ready, and it's Klebsiella Okay. linezolid is still okay, but it's not it's more under your gram positive. But you can add up another form of antibiotics in the form of piperacillin because piperacillin is good for your Klebsiella All right. So it covers you know Klebsiella definitely okay, but you cannot give an antibiotics and amoxicillin call a Moxie club for a patient having Klebsiella because it's a very strong kind of microorganism. It has to be a strong antibiotics as well. And definitely you cannot give your daptomycin linezolid for a simple colds. Alright, or let's say for example, your community acquired pneumonia because these are very strong antibiotics. This is the very purpose of this antibiotic ladder.

Did you get that? Okay, let's take a look at other forms of infection. For instance, we have your UTI. Okay, you have your UTI if your patient is let's say for example is pregnant. Okay? pregnant. Pregnant women should get amoxicillin that's very safe. Okay, amoxicillin. Well, if you're if your patient is having some form of fever for example, you can add up with your beta lactamase for instance, your because this is UTI  is mostly common, which is mostly caused by what your E coli, right your E coli. Alright, so, E coli, this is a gram negative microorganisms. So amoxicillin is fine, right? If your patient is developing fever and then okay. This could be another form of microorganisms so I can give clavulanic acid which means to say your core Moxie club do you get that for pregnant women? amoxicillin is the base antibiotics for a patient have been you know pregnant is a safe antibiotics for patient have been Yeah, I mean a pregnant patient okay. For a woman having UTI which is common to women. Okay. I would say your nitro of urine point. Right your night Have you run point Have You Heard your night Have you run point in a form of your Macrobid Okay.

You normally see that for a patient have been women who have Having UTI but not necessarily pregnant because if you're pregnant again amoxicillin. Okay, so women nitrofurantoin I'm not really sure what's the study, you know, what makes the women more responsible to nitrofurantoin instead of your trimethoprim trimethyl Priem trimethoprim sulfamethoxazole. The bad thing about it is that in the US, there's lots of sulfa allergies. That's why they don't much give treatment to prevent instead, they're giving ciprofloxacin, so this is very universal. Your ciprofloxacin, okay, your Cipro? florin. So what is this timing? trimethoprim sulfamethoxazole are also known as your bath trim. Have you got this medication before? Okay. So this is usually responsible, usually very effective to a patient having as long as the patient is without ESRD. Okay, as long as the patient is without ESRD or without renal disease. trimethoprim is very effective. Okay, that's your bathroom. Okay. But the thing is, like I said, there's lots of people here that are allergic to sulfa.

Okay, because it contains sulfonamides as well. So again, that's your bathroom. That's very good for a patient having UTI as long as the patient is without ESRD. Okay, as long as the patient is in doubt, ESRD Ciprofloxacin for any kind of UTI if you think about it, as long as it's not pregnant. It's also responsive to women. Okay, Ciprofloxacin is very good. So let's just put it here outpatient, they can take it p O, they are ambulatory. They're not really sick. If the patient is sick, for example, and then they came to the hospital, okay? Because they have a long standing, for example, like Foley catheter, that makes them really sick. Okay, so what can you get from the from the catheter, there's a lot of them, it could be gram positive, it could be gram negative, that's why you know from a Foley catheter, this is basically your catheter associated urinary tract infection. So, these are another you know, antibiotic resistance kind of condition. You can get it from you know, hospital. This means to say that these patients are sick.

You get your SIP triazole alright, you receive triazole can you also get your Levofloxacin? Levofloxacin Yes, you can also get people Levofloxacin Because they were Levofloxacin. If you look at the baseball here first base, second base, it both actually covers gram positive and gram negative but it's more on to your it's more on to your gram negative. So it means to say it covers gram negative, you can give that to a patient have been UTI. Okay. So if trials or liberal flops are seen now, if your patient is really sick, can you add up something part from your supplier? So why not your piping? Rassilon? Can you add that? Yes, bypassing is a very strong antibiotics for work for a sick patient, gram negative or gram positive. And who knows that UTI is already coming from MRSA. Remember, MRSA is staphylococcus is gram positive. So that's your piperacillin covers gram positive. What did they tell you? It covers gram negative and as well as your gram positive means to say your patient is safe. As long as the patient is sick having UTI? How do you know if the patient is sick, you know, are coming from a UTI.

Your patient is having fever. Your patient is developing some hypotension and who knows it's already septic shock. Right? Your patient is already confused, which is very common to an elderly woman here. I don't know what's the relation between the brain and the bladder. Alright, for that matter why they're confused. But anyway, so these are the common antibiotics given for UTI patients that makes them sick as well, because they're already confused. These are signs of impending sepsis. All right. And again, like I said, Who knows it's already septic shock by looking at your blood pressure, which is also already going down. All right. Are we still learning guys? Your cotrimoxazole Yeah, that's they will also give him that here. Okay. But these are the usual things that we're giving here in the US. Okay. So again, most commonly, as long as the patient is not really sick from that UTI, we give your Ciprofloxacin if the patient is developing fever, you would think that it's already ascending. It means to say it's not because when you say like UTI, it's supposed to be only in your bladder. cystitis if you It's recurrent. It's recurrent. It means to say it's already ascending to your kidneys.

It can develop by linear Fridays. That's the very reason why you're having fever and chills as well. You are sick, you need to get stronger antibiotics. If you don't have a fever, you don't necessarily get Sif triazole. You can only get like ciprofloxacin, you can get for example, your bathroom. You can get for example, for women, you can get your Macrobid through your night of your Android. Alright, so when these are the common infections, I may add some form of let's say for example, your wound infections. Okay, in here, what did they tell you earlier? I told you earlier that hospital acquired infections may mean community acquired infections, hospital acquired infections for me are you know, it's overrated. Practically speaking, because you see patients have been hospital acquired infections already. I mean, underrate, I would say like underrated because even if the patient is just confined in a hospital for less than 24 hours, that microorganism is all you know, that kind of microorganism is supposed to be acquired in the hospital. However, in the community, it's already present. They come to the hospital with MRSA. Okay, so what infection so I would say that it is MRSA.

Okay. MRSA consider that as an MRSA, that's why and then they come to the hospital who are sick. Other words these are toxic patient, which means to say they can be sepsis, septic, right? So what's our medication of choice for one infection? Okay, are you getting me here? They come to the hospital, they are very sick with wound infection with cellulite this to be specific guys with cellulite this, that's most likely MRSA. All right, they were not able to take care of their wounds they acquire more strong I mean stronger microorganisms which needs stronger antibiotics as well. vancomycin, there you go, vancomycin, so if you see your patient, which is very common also for your NCLEX, and I always see that, you know, from  day to day of my job in the US here, by the way, I'm working in the medical surgical telemetry floor, where I don't handle patients though. I'm a regular charge. Anyway, in vancomycin is a drug of choice for MRSA, like I told you earlier. Again, if the patient comes into the hospital sick looks like septic, who with that kind of wound, consider it's MRSA. What's the drug of choice? vancomycin?

Alright, sometimes the patient is it's been recurrent. And you know, for the fact that MRSA is a resident. If you had MRSA before, most likely if you had some form of you know, once you can have, it's the same thing, you know, you can have MRSA. On the second time around, you will have one because they are residents, it will stay in your body. I'm gonna tell you guys, because these are stronger, you know, kind of microorganisms. The drug of choice is vancomycin, can you add up some more? Yes, you can add up piperacillin that's fine. Okay, bye. Rosalyn covers what gram positive and gram negative as well. Staphylococcus aureus, okay. But this is resistant anymore to your to your nafcillin resistant to your dog's insulin resistant to your what's the other one? Anyway, so resistant to those medicines. Okay, so MRSA, so you give something else which is stronger because again, they're sick. Okay, so I guess no more questions. I mean, do you have any questions guys? That's all for today. If you want to repeat the discussion today it has to be posted in Connetics to see you know, at least to review because I'm always telling my students as well in Ipass that repetition is always the key you master you know you master things your master stuff by repetition.

Okay, whether you like it or not, you will you know, you will agree to my, to my opinion in everything that we do. We have to master not necessarily everything that we do, especially in conquering this NCLEX you have to master the concepts you cannot master I'm talking about NCLEX guys, you cannot master the concepts if you don't repeat it. So it's the key to your success in your index. What did they tell you earlier? Don't stop until you get proud to yourself. Alright, and one thing for sure also for resistance. Okay, persistence, you have to push through. All right. And if I can remember from the famous Jim, Jim Watkins, a river cuts through a rock, you know, the river, right? They got through the day cut through the rock, not because of their power. It's not because of their power. Water is not as powerful as he was, what do you think, you know, to cut through that rocks? If you see some rivers, right? They have lots of rock formations in there. However, it's not because of their power, but because of their persistence.

Again, like I said, a river cut through our rocks, not because of their power. They cut through rocks because of their persistence. Okay, and it seems like the routes are really you know, hard. But with your persistence, you are able to get through those rocks, those adversities, those struggles. And you will be able to say, Yes, I made my NCLEX okay. And God bless everyone, of course, you have to be guided by the man above the Almighty in order for you to do you know, this stuff. God bless you all and have a good one. Okay. I guess there's no there's no more questions, I guess. And hope you liked my lecture today. Like I said, you can see the you know, the recorded version, you know, posted in Connetics as well. If you're in high pass, you can also see that in your iPad page. Have a good one everyone. God bless God bless God, this Thank you, Mr. Melanes, for this opportunity, Connetics Nursing Agency all in all for this opportunity. Okay, thank you. Thank you.