#50: Drugs 4 Bugs (Part 1)

*Music* *Music* *Music* *Music* *Music* *Music* Hello! Hi Sashi! The sun is shining! The tank is clean! The tank is clean! Starting off with an obscure finding Nima reference! It's very. *Laughter* I love 2014! Because you're meant to clean your car in your way here! Oh my god! Who didn't clean your car? It's disgusting! It's actually disgusting! My car surprisingly looks great! What happened? There was a dust storm! Maybe it was the north side dust storm! It's disgusting! Who has clean cell days? No really! You have clean cell days! Yeah because at work there's like a clean machine to get a Pepsi Max! And I feel like the only thing stopping me from getting a Pepsi Max every shift is the fact that I never have a clean cell! Who wants a clean cell nowadays? If you like a Pepsi Max! No I don't! But maybe if you're a clean cell! But on your shift at like 10pm at night you're just like "Lonely, you get through the next two hours, you just want a Pepsi Max!" Yeah! Am I wrong? Do I lie? Do I lie? Hi! The guest bag! This is so nice! Best to basics! This is not 50th episode! Crazy! Can you believe it? That's wild! I know! I know! And I feel like this is the topic that like emotionally, spiritually, like metaphorically, but also not Because me and you were like little nebish first-team members And we were like "What the f*ck, everything!" And there I remember I made a new monic for gentomisin And the two of us just looked each other and it was like this light bulb moment to be like "Oh! We can do this? This what?" What was the gentomisin? Oh no it's coming out! Okay but now I want to kind of remember it! You're a member of the room! I have to go on with the finding nema memory, the memory of, sorry not yet! The finding nema analogy! I have the memory of a goldfish and I know I remember nothing of why they started and how And all I mean is like, deep in the textbooks of pediatric exam studying And very far from where we were as first-team medical students So I'm less far from where we were But I'm a safer exam just yet! It sucks but it's also incredible but also To explain to the listeners has been a big part of why I can't do podcasts anymore Because as soon as you start learning more than med school you're like "Oh I know nothing" And then you feel really embarrassed all the time but now that I'm kind of getting to the point of sitting the exam I feel like I know enough to teach something without sounding like a complete idiot But also it doesn't matter It doesn't matter! Listen! Today we're talking about antibiotics and this podcast Dear listeners, it is for medical students, nursing students, pharmacy students But don't judge us pharmacy students Anyone who is starting up their medical or health career and you want a bit of Neumonics to try and understand antibiotics To property and antibiotics you need like a six week full course You need a three year infectious disease advanced training We should give a new basics We should aim for people who go get prescribed an antibiotic And then they read the back and they're like "Oh this is a moxie kind of means" "A moxie cylinder" "Wait what does that mean?" And like just the lay person "What is an antibiotic?" The suffering basics again No I've found with study you have to do it again and again What has it resents? This is our repeat I'm going to force into your brain and you're just like "Alright well it's in there now" Hopefully for ever this time probably not And should we start? I think we should start I think we should do it Guys I'm feeling good I'm locked down too Over 90 days Many days of zeroes So that's how we're going to see each other in months Yes definitely feels good It's lovely It's a little bit like a cat It's going to be lovely But first the blood mask I'm sure listeners are like "Oh god yeah I forgot that they rambled a lot" They're like "Yes we did" They're probably like "I want to hear more about dinner" I've experienced study Let's just talk about this Should we do a lifestyle episode? Where we just talk about how we want to decorate our houses We're like "Oh I never want to decorate my houses" I'm not going to Pinterest You know what I'm also going to Pinterest But you know what I am into? Home Depot TikTok I want it I think TikTok is the passion Okay okay, no we're positive conversations I love TikTok, TikTok has changed my life Not sure if that's for worse But let's talk about it Okay can we take a break halfway through Because I have like an idea for the palette Of where I'm moving and like what colors keep my one And I want the listeners to wear you You know it's a one-way podcast The cat responded really well We love Instagram now I think it's like a two-part podcast And in between the first and second I want there to be a poll about the color scheme But I'm the fat one, please start Okay I also genuinely want to know all that But I'm going to get into the podcast And get us to get to the end No that's fair, that's actually an exciting topic for me But so is Antibiotics and on that note Let's start with how to take an infectious disease history I love it Now this is as you know because I said every single episode I only like some acronym in the morning And this is a good one I think Chicktoads Bazaar What's a chicktoad? A chicktoad is how you take an infectious disease Is it like a chicktoad? I just don't know It's more like a chicktoad It's a fancy toad Or a crust potato chicken in a toad Oh god I don't remember that Oh now I'm going to remember that Like you've got a fever, what we'd want wonderful things to do eat A chicktoad Well don't hate that Okay, chicktoad C is a country of origin Relivate for things like Could be a B, have they been vaccinated H for housing which I think specifically means are they housed? Or not I for immunizations Which wow wow wow Typical, topical, topical But not everyone is vaccinated Looking at you, Peter Evans I don't know C is contacts And went around their music T is travel which Oh my god during the pandemic It sounds like an absolute full-asked question I'm just like don't laugh at me but how do you be anywhere And they're like you're joking And you're like I'm just checking some people Yeah, totally Or for occupation, what do they do for work And specifically like you know we're higher risk Really? Not in the things like needle sticks and covered But you know we are We're actually so ready by people who are sick Yeah I'm pretty sick Covids like in person and on other podcasts And in a struggle every Oh, it's a covid It's like you always say "covid" Covid I had some of them call it "covid" Covid The covid, it's insane Sorry, okay I'm almost intentionally derailing this because I hate And who are these? And I do so much Go on, okay we're out to operation Is for animals So like have I been in contact with any animals I got a cat recently which is hard to not bring up at any moment of any day But you know when I first got her I was like oh my god Am I higher risk of having fleas But I don't think humans get fleas Published into that Deep drugs And so are they on immunosuppressant drugs And therefore they will like to get things But are they also you know ivy drug use Which can also lead to other bugs And then S for sexual history So chitone, so sexual contacts Contacts, contacts Very good I like that because it's sort of all the things that you should be asking for in a social history anyway Yeah I like to know it because it's hard Exactly But if you're being thorough Especially I guess if you're looking like you know someone has like some sort of a picture that you're like It's not something common So what weird and wonderful place could it come from Let's go through this with a fine tooth cone Exactly and it covers everything And I think that brings us to Well we're talking about antibiotics So like what a bacteria and let me say In reference to what you said I don't think I think it's very few people that they actually like antibiotics Okay I think it is the most stressful topic You know? Which is why How many times have we said to each other we need to do a topic on antibiotics And we have been avoiding it because we're terrified of it So we're trying to make it fun deal Is that trying to make it fun? I have a fun antibiotic I'm really excited to get to it So let's just keep zoom So the next thing and we're just going to like Brush in this you like antibiotics What are they for? What are they for? Like bacteria Yeah? And I remember like back at the satin med school Such recently but the satin med school being like What's the difference between virus bacteria and fungus? What actually is it? So easy! Viruses, they're not living? There's no cells. Do you think people know that more now because of the COVID? 100% they like understand. Definitely. Cannot kill with the virus with the antivirus. And I actually kind of love how much the general community is like, now you can't use antivirus because this is a bacteria. This is virus, not my guess. Education. Can be spread on surfaces. Viruses, non-living, no cells. Bacteria, living and one cell. And this is lots of cells, they're like a complicated organism. All bacteria is just one cell. Apparently yeah, that's crazy. I love that. That's quite simple. So crazy. And then we care, oh my god, it's like all coming together kind of. Because the next part is we care about the cell wall, right? Yeah. Because the only way I can remember to differentiate between different bacteria, aside from whether they're round, gokko, or whether they're raw shape, the cellite. And then they can be spiral, spanky. I don't know if these are right, but something like that is whether they're gram positive. So they stay dark, like dark purple, or gram negative. Because they say like to peak. Yeah. But I don't know which or which, but I kind of know some of them. gram negative a peak. Yes, excellent. So that's because of their cell wall, right? Tell me, what's the difference? Okay. It's to do with how much peptidoglycan they have in that wall that's like surrounding them. Yeah. And peptidoglycan is, I don't know how much detail you want to know, you probably don't want to know anything, but I want to tell you about it. I'm going to. So peptidoglycan is made up of, it's kind of like, okay, imagine the bacteria is wearing two pearl chain necklaces, which is what I stole from Osmosis videos, everybody should watch them, right? You're wearing two pearl chain necklaces and the necklaces are connected with like whatever you want, something pretty, right? Except in my analogy, it's not pearls. It's like, if you, you know, we have a little and you're making yourself necklaces out of beads. Yeah. And you thought they were really beautiful, but they're actually really ugly. Okay. Mine were beautiful, but I rise. So you're making them out of like these chunky beads and one's called NAM and one's called NAM, but we don't care about that, but they're alternating. So it's like blue green, blue green, blue green, blue green. And you have two of those, right? And then. And then there are bits on either side of them that point out towards each other and they get stuck together and that's what holds the beautiful necklace together, okay? Okay. This is the sew wall. But actually the bits that connect them are made out of hammer beads. Okay, okay. Have you ever used hammer beads? Of course. Hammer beads you have to iron, do you get them to stick together and that makes it super strong. Yes. That's the peptidoglycan sew wall. And we're going to come back to that analogy later when we talk about antibiotics. Okay. How fun is that? So, okay. Great. Love this. Love the jewelry. And then there's the chunkia jewelry. Yes. The thick of the peptidoglycan gram positive. Yes, because of the thick peptidoglycan layer and it is parable. Super thin, gram negative. Great. Okay. How can we add this in? So, gram positive has a thick peptidoglycan layer and it's purple, but there's no outer lipid membrane. Oh, I don't know. But gram negative has an outer lipid membrane. Oh, right. Because they've only got that thin necklace. Got it. So they need to have something like a short. Got a short, a protected. She's more of a classy lady. She doesn't wear like big chunky jewelry. She wears like something thin with a short one. Love it. Love it. I feel personally attacked because I can no longer open my necklace right now. I'll get you a short. You think so much. No, I want headaches. He said, "Jog, have a baby." How about these? I hate headaches. Oh my god. I'm obsessed with the personality of people. Keep going. That's the one's next to my heart. Okay. So I need to dig into actual antibiotics. So, listeners, the most important thing we can remember is that technically, if you get a big, whopping antibiotic like Tazasin, it will work. But that is not what we do. It is better to get a narrow spectrum antibiotic to work on a known organism rather than broad spectrum one. Why will firstly it works better? You don't want antibiotic resistance. It's safer for the patient. It's a remembering targeted therapy is better. Other things to remember are all therapy, safer, cheaper, IV therapy is obviously really important hospitals, but you don't always need to do it. And some actually work better early, especially if they need to go into the gut because what better way to go to the gut than straight into the gut, which isn't your mouth. Maybe a good way to put that for our internal and medical services. If you have to call the ID red to get approval from the antibiotic, it's like, "Oh, okay, I mean, broad spectrum, territory, they don't want to use that." Whereas if you can Google it and not Google it, like look it up on the guy, but you don't find a very specific one to use. Or if the like sensitivity is for a swab come back and it says this is sensitive, this is grown bacteria and it says into this, you're doing better than when you just call the ID red to like, "Can I give them more Tazasin?" They'd probably be like, "I know you have a bugged." I think that's why they made that system because if you have to call them, you're like, "I really need to know that." Yeah, I need to double the amount. Alright, so let's dig into it. So the first, so there's three main sections, yeah? So section one is antibiotics that inhibit cell wall synthesis. And I like to think of it like, first we start with the antibiotics that attack the outside of the bacteria, cell wall. And next is the one that can get inside and mess up with how we make DNA. Exactly, so they inhibit the nucleic acids synthesis. That's right. And then the third one is stopping that DNA from going on to the ribosomes and making proteins, which the bacteria needs to like be about our bacteria. Right? Yes. So it's like, "I think you're punching into the cell wall or you're getting into the DNA or you're going all the way down to the protein." Love that. Love that. There's a three categories. So let's go in order of all of that. Yeah, let's start with this cell wall. Well, she was starting with penicillin. Can I tell you what a beta lactobus? Oh my god. This is something in Ben's school, we would be like, "No, what?" I don't care. All I want to know is what penicillin was like, how to memorize it. I genuinely could not remember it until I wrote this. Okay. Okay. Back to the hammer beads. Yeah. This way. I think it's so funny, you mean, I thought about it in the shower. I was like, "Oh my god, I have to tell a character." Imagine, right? That instead of having a big iron to iron those hammer beads together to keep your necklace change together, it's a tiny little iron that only fits on top of your hammer bead. Okay. So it's like shaped that pattern. Okay. Right? You've got tiny little iron. Oh, it's a second. Beta lactams are a bunch of antibiotics which include like the penicillins and the Kepler's boron that have this ring that smushes and fits into that spot where the hammer beads should go. So your tiny iron is called a transpeptidase because it's an enzyme that smushes together the peptide chains. Yes. So the beta lactam comes and sits inside the tiny iron. So it can't iron the hammer beads. Oh my god. So you can't put the peptidase like a chain together. So you can't make your necklace. And it's all floppy and loose and it's going to break. And you can't wear it. And it goes in the bin. Okay. Cool, cool, cool. That's a beta lactam. Okay. I don't know if I've ever had a soda until this exact moment. Oh, but I've literally never got it. But it's all, but it inactivates this transpeptidase which is called the other name for a transpeptidase i.e. the tiny iron is a penicillin binding protein. So it's literally like they made it easy for us to remember. That's amazing. Anyway. That's a beta lactam which includes penicillins. One of the downsides of doing a podcast is that you cannot see the joy coming out of Sarah's eyes that are genuinely sparkling the moment that she has understood the path of his life. You have this? It is a joy to watch. I'm sorry, but also because Karen is like, oh, I'm like path of his job, you know, which is fair. I didn't either. But when you do know what you're like, oh, she's good. If it's not obvious, the structure of this podcast is going to be session teaching all the pathofies and main teaching in a body. Yeah, tell me them. No, no, no, no, no, no, no. Okay, so there's three types of penicillins that we're going to talk about. We're going to talk about benzal penicillin, flupoxic insulin and amoxicillin. Amazing. Okay, so the first one is benzal penicillin, which is colloquial, you know, it is benhen. Benhen. And in this scenario, I'm going to say it's ben10. The popular children's television show. That's still popular. Still popular. Definitely everyone's still watching it. I have no idea. But Ben10 is like, I think he's like a little boy and he has his cool watch and he's like fighting and like saving the day. And Ben10 is like, he's really happy. He's really positive. Cause it's gram positive. Woo. Yeah. But it also has a bit of gram making an ad or a cover, but predominantly gram pose. But Ben10, it's really targeted towards kind of young kids who like action. Yeah. It's really narrow spectrum of you. It is a really narrow spectrum of TV show. Really, really narrow spectrum. Only a few people are going to watch Ben10. But also stereotypically Ben10 is trying to like get a like the boys in. So it's a lot of, and I have to say, cause we haven't given it a disclaimer. This is like not a PG podcast. It's been a year episode before. Just like know that this is the way we remember things. It is purely for educational purposes. Describe a disclaimer, ding, ding, ding, ding. Anyway, so it's a lot of boys, so it's a lot of cocks. She was like, where am I going? I was. I was like, don't remember. It's happening. Stress. - No. - No, no. - And ninja cockers, noobah cockers, all the cock's. - Really good. - However, Ben tends running around as action film and there's a big sign that says do not enter. - Uh-huh. - Because it doesn't cover enter the cock. - Oh, that's really good. - All the cock's except for not enter a cock, 'cause they do not enter science. - Do not enter, that's very good. - Great, hey? Ben, 10. - The other thing about Ben 10 is like his whole stick is wearing a watch here. And I think of like the handles of the watch poking into things. Because it's I am a IV, it's not RO. - I know. - Very good. - And you're seeing a lot of these in Monix, I'm trying to make it really clear when things are RO are I-V, and trying to incorporate this in there, because one of the things that's really hard to remember early on is what's RO. - Ben 10, Ben pen, stick stick stick, only I am a IV. - Mm. - Is that like where you were watching is where you would be trying to put a cannula in. - Exactly, exactly. - There you go. - Ah, the wrist, my favorite spot for cannula. So easy. And Ben 10 is always running, and in this whole thing, running is like a metaphor for running to the toilet. - Oh, 'cause of GIs, not this? - Yes. - Okay. Okay, all right. Can I quiz you on what I just told you? - Oh, okay. - Shall I promise you that I'm not gonna be harsh? We're gonna do this. I think this is gonna work. - Okay, I thought we weren't gonna quiz each other. - That's a good moment to say that. - You can do justice one. - So, how do you administer Ben pen? - I am, or I think. - Yes. - Which organises mostly? - Cockers, cockers? - Yes. - Grand Positive? - Yes. - Because they're super positive pumped up Ben 10 fans. - Yes. - And not enter a cockers, 'cause you don't enter. - But all the other cockers, are stripped of cockle and mentioned a cock, mentioned a cockle. - A luma cockle. - Yes, done. Yay. - You know what I did. - Love that. - Cool. Should we do the next one? - Yes. - Okay. So, the next one is Flu Cloxicillin. Oh my gosh, from your face, I think you remember it. - I can only remember what I use it for now in pediatric, which is like skin infections is Flu Clox. - Yes, yes, but how do we get to that remembering device? - I don't know, 'cause I forgot how to do these. (laughing) It's been a while. Tell me, Karen, tell me. - So Flu Cloxicillin. - Yeah. - Flu like flying. Clox like clocks. So you're thinking, gosh, I wish the time was flying. I want this clock to fly. Flu clocks, flying clocks, and specifically, who wants time to fly? Well, no one more than staff in an office. - I can't wait for the day to end. The staff are just like send me home, let the clock go faster, I wish time would fly. So the staff in the business can go home. Do you see what I'm going with it? (laughing) Listen to Karen's face when she comes up with these nomonics. Must be the same as mine when I'm talking about the bathroom in the middle of the cheek. Beaming, beaming, beaming. I don't know if anyone is still listening and being like, I don't get it. - Star is staff, staff of the caucus. - Yay. - Because Flu Clox is staff. And if you finish his podcast and all you remember is Flu Clox is staff, you've got to remember that. - It's very good. - It's so important. But when you're fresh in men's school, like you don't remember these things, of course not. So, staff, Flu Clox, which are skin infection. - One for time to fly. - Uh-huh. And really the staff is so excited that the time is flying. So I feel very positive. - Because it's a lot of fun. - And it's a very narrow spectrum of use because honestly, flying cult locks don't actually exist. So, you know, it's not really feasible, maybe not yet. - And also it's possible to tell the time either orally, hello Sarah, it is 4.30 p.m. - Or to jam people with a clock hands. - It's IP. (laughing) And it's not, it does not cover MRSA, which is a whole topic in itself by definition. But again, that whole, like the whole thing of running with everything one thinks to go fast, you're running to the toilet. So just imagine, oh, I really want things to go faster. So you can run to the toilet as well. To be able to do every antibiotic has GI side effects. So it's kind of like, where? - Where? - You know? When people are like, I'm allergic to antibiotics, I had diarrhea, it's like, no, they all, they all have GI side effects. - I get it. - That's very good. - I would have be. - I would have be. - I love the flying clocks. - So, step warriors, on your skin, staff in an office, staff, staff, flu clocks, flying clock, time. We're getting there. And if anyone is listening and they are not vibing this, you should probably just turn off now. - Yeah, 'cause this is-- (laughing) - If anyone thought this was gonna be some sort of like, serious, just get into the pool of antibiotics, (laughing) - It's very new. - Okay. - Okay. - Next one. - Next one. - Yep. - Is this our last penicillin? - This is our last penicillin. - Very good. - Kind of. - No, it's our last antibiotic. - Like it, yeet. - Now, this one may or may not have aged, but I'm gonna go with it. Because I can't think of anything better. I don't really like it. So this is a moxasillin. Yeah? A moxasillin, which often is in the form of apacillin and augmented joyful, which we get to in a second, but a moxasillin is a really common drug. - Yeah. - And I like to think of moxy tampons. Now, for anyone with a uterus who has periods in Australia, you probably know moxy tampons as like the bougie tampons. They're like, they got their whole nice packaging. - You're like, came in like a little tin. - Yeah, it did. - A little tin with a boom. - And they still exist. I double check, came in this warehouse website. They exist now. They also stock some menstrual cups as well. So we're for them moving forward. - So moxy tampons, why have I remembered moxy tampons is because they're trying to put a positive spin on periods. Yeah? They're really like grand positive because they're trying to put a positive spin on them. - You can imagine them in the boardroom at moxy headquarters being like, we really need to put a positive spin in these tampons. They've got it a bad rap. - But they also kind of sound negative and sound anorose but predominantly grand positive. And it's very broad spectrum. - Why? Because, you know, so many people out there have periods. - Huge, huge, huge market episode broad spectrum. - Almost 50% of the entire world. - Yes. - I'm curious at some stage. - Uh-huh. Now the reason, and I again, disclaimer, disclaimer, disclaimer, this is not a PG rated podcast. Why have I kept moxy tampons? Because if we remember back to Ben Hen, Ben Hen didn't cover. - Enter a caucus. - I'm not enter. - But a moxasilla, they enter you. - They cover you. - Enter a caucus. I'm so sorry. - I'm so sorry. (laughs) - It's so good. - Ah! - I know, I know. And if that's all you remember, yeah. I also remember that a moxasillin is also kind of, so moxies are all and then abasillin is the IV. - Yeah. - Because you get cramps with your period. Cramp, abasillin. - Oh. (laughs) - Okay. - And then you have-- - And a moxie got the, oh, did you already say that? Oh, parrall. A moxasillin. - I like that. - I don't think of that. - That's great. And then you've got kind of, so it's a moxasillin, abasillin, the other one is augmented duo IV, which is really common to a moxasillin and clavillonic acid. - Which is just a moxasillin duo. Is there like double the dose is the IV day one? I don't know. - Yeah. - Moxas, augmented duo. - Yeah, I mean, augmented duo IV. So we've got clavillonic acid, which inhibits some of the bacterial beta-lactamases. - Yes. - So it's spoken about. - Which I can explain a little bit more, it's just that. - Yeah. - When the penicillins were formed. - Yes. - And they came up with this beta-lactam ring to come and interfere with the tiny little iron that they're transpeptidase. - Yes. - The bacteria got smart, and they were like, I'm going to make an enzyme called beta-lactamase to fuck with your beta-lactam ring. So you can't get in my iron. So they're like, "Chop, chop, chop, get away!" And so it would chop up the bit so that iron could do its business, right? - Basically. - You get on those hammer beads. - Amazing. - And so adding in a beta-lactamase inhibitor, like clavulonic acid, and also like a pretty sure tazabac dam, which is the tazas part of tazasin. - Yeah. - Didn't know that either. Is you add it to the penicillin to be like, "Get out of here, beta-lactamase." - What's up with my brain? - I'm getting back in the scent. - This iron. (laughing) - Anyway. - So good. - Yeah. - There is one final thing with a moxicillin. I'm bare with me. Again, the weirder than a moxicum or a comfortable, it makes you the more you remember it. So the other thing with a moxicillin is that if someone has ebv, etching bar virus, they could have a rash. - Oh, yes. - Yes. So, if someone has tonsillitis, which is often ebv, often leads to tonsillitis, you don't want to give a moxicillin because it can cause a rash. - I try to think of like a movie scene and like two people are kissing and someone's like, "Oh, we can't touch tonsils because I'm on my period." You know, like that type of vibe, yeah. - I'm a rash. - We give a moxicillin. - You don't, he never gave me this. - At Sanate for tonsillitis, for noxymethylpensicillin. - I don't have any of that. - It's too long. (laughing) - And it hasn't opened it for aryls, for tonsils. - Yeah, look there. And that is moxicillin. If you don't like the whole tanapone metaphor, the other one, moxie is also a chain of hotels. Into the hotel. The tanapos is better. Look, you're on it. (laughing) - Oh my god. - And the final penicillin that you need to know about, and I don't really have an amonic for this, because there's so many memes that exist on the internet, these tazas and otherwise known as pip taz, that's what we just said. Pipericillin and tazatbacter. - Super extent, they apparently, are going to, again, as Moses plugging them, and I've been watching a lot of those videos, is that, like, bin pen. and phynoxy is narrow, a moxie and ampie is like broad, and tazza back term like piperous cillens and ticurous cillens and other stuff like extended spectrum so they're even bigger. Yes and their things, therefore like the really intense things like for example if someone comes in with you know if they're around you to pee, yeah tazza sim is what you're giving. Tazza sim is like a big guy and there was so many memes about tazza sim it's a great meme thing. Is it? Yeah but when I was like at our first year in hospital and we were like which which tazza, which anybody to give this and it was like a staff infection which is didn't know what like tazza sim is and if I remember I drew this made like yes it will work but you should have used tazza sim it's the big guns and we're like ah okay quick quiz I promise I'm not going to put you on a spot you'll just know like it's fine I'm ready now I feel mentally prepared. What do you use for staff? A staff is the staff in the office and you're wanting the time to fly. So fly clock's fun. Yes, fly clock's a sim. Okay what covers enter a caucus and what doesn't cover enter a caucus. Do not enter said Benton. Yes Benton. Yes and then enter a moxasillum. Nice. Moxie tampons were enter. Amazing and if someone has ebb what antibiotic can lead to a rash again a moxasillum. No. Because tazza and don't want to kiss. And finally Benton is good for what organisms. Oh we're going back to Benton. You said I would know this. The Cox. Yes. Because Benton is good for boys. Yay. And that is the Cox. All the contestants. Yay. Not all of them there are more but those are the main options. This is a good start. Again these are just that these are the stock standard intro antibiotics. There's always more. There's so many more. Because if you went to body like last year and I was like please no. And then we're going to talk about the kef for the next one. What archival is born. So who are they? They are she. Well she's also wearing a beautiful pearl necklace. But getting fucked up by the whole harmony thing that I said before. But it's also made a lector. Yes. Did you know this before? I did not. As in obviously we were not. I'm sure I knew it. But like it really takes a different vibe when you're in hospitals. Like penicillin is one thing. Yeah. Keftraxone is something completely different. I didn't have them together in my brain. It's both being beta lactams. Yes. It's another mucking up your little iron. Got it. Dude, do people even know what I am? Do people even iron clothes anymore? They're like harbobies, eyes. I don't get it. I have an iPad. Basically it's like a necklace, a beta necklace and there's lots of necklaces in a row and then in between the necklaces to get them together you've iron little tiny beads between them. Yeah. Just wash them down and melt them together. It's a very safe toy for children. Wow. Wow. Wow. Wow. Wow. Wow. You get your mama to do it all. Someone supervising adult in aftercare. That was my, that was my mother who would leave me after care. Anyway, Keppler's Florence. I also bear the lactams. Tell me some of the, are you going to teach me about some of the kids? Let's do it. So there are four generations of Keppler's for you. They're actually apparently five now. I know. I'm sorry. There's probably like six or seven videos I watched said five. Wow. I think. Do not know that. I hope that's right. Oh my god. I have to try to. Well that's five or is it 12 generations of Keppler's? You must know each one. Okay. Well there's four or five but either way I'm just going to teach you about first and third gen. Love it. All interococci are resistant to Keppler's Florence. Let's stop that interococci and on-go-free thing throughout this. Keppler's is so nasty. Oh no. So tricky. Keppler's Florence is mostly grand positive. And they have, yeah, as we said a very similar mechanism to action. So if someone is out of Lexus to Penicillin, there's about a 10 to 20% crossover with Penicillin. And I'm just just being really conscious of that. So they give you a little tidbit about peeds. Cool. They give you a little tidbit about peeds. Oh my god. Peeds don't end up to it. But peed, deacchic population will often come in with a coffin of cold. Yes. And then they've got a virus but the GP might think that it's bacterial. So they'll give them something like a moxasillin. Yeah. Cover for some sort of bacterial infection. And then they'll break out in a rash which is actually a viral exam. Them a rash that you normally get with common viruses. Yes. And then the parents like they had a reaction to the antibody. Yes. And you're like, did they though? We don't know. Let's give them that antibody now that they're in hospital. And figure out if it's a real reaction or not. Which really goes to show that really you don't need antibiotics unless you actually need them. We get very antibiotic. I think there's a huge move now to choose wisely. If you can't do it, don't be afraid. Don't be afraid. You'll see what you can do. That's what this one says. So there are two careful spines I might speak about. Has it got to speak about a first gen one and a third gen one? First gen is kephalexin. I'm going to speak about. And then I'm going to speak about a third gen keph triaxone. There's lots of other ones but those are the two that you probably need to know the most. So kephalexin. Otherwise there's kephlex. Oh have I changed my voice to talk about this one? Yes, why? The kephalexin sounds like kephalexus. I have a lexus. La la la la la la la la la. I'm a little bit of lexus. La la la la la la la la. I've got to be my lexus. No, no, no, no. I didn't know you need a dance! I didn't really do the dance. I just dropped it once. I'm impressed anyway. Oh, I love it. Why is Kim Alexus a little bit of Lexus? Alexis? There's only really one thing that I need to remember this is that the sound Lexus. it's swanky, it's sexy, it's a Lexus, it's a little bit of Lexus. It's all the things that start with airships, strip and staff. That's it, that's all I asked. That's it! It's also a swanky car, so it's first generation, it's number one. Oh, that's good. As well. That's a long way to go. I get to S. You're feeling really positive about it because it's a beautiful car, but really, careflex, strip and staff. Okay. That's really where I'm getting at. We got that? I don't know if you have a little dance in the middle. I actually had to sip away. That was amazing. I wish this was a video sometimes, and all of you could see Sarah's step away and doing the little little little Lexus dance. Maybe we should do that in the future. We'll have a little camera just there. Some people can watch us. That would be wild. That would be wild. Maybe we should. We're like, we'll do a podcast so we can always go for jobs in it. You know what? Okay. The third generation one is calf triaxone. Calf triaxone is one of those medications. If you had to know any men, you'd have to know calf triaxone. Okay. It comes up all the time. Yeah. So, really simple way that I'm going to get you to remember is calf triaxone. Okay. Because it's a third gen. It is a third gen. Yeah, yeah, yeah. But we can use the tri. We can really push that tri manifold. So you need to give calf triaxone to your triing really hard to get the cannular in. So it's IV. Yeah. It tries really hard to hang around longer so it's got a really long half life. So it usually only gives calf triaxone daily. They do triaxone. And tri three. We've got that three tri for generation. The other three is baby bee. It crosses blood brain barrier. That's why you can use it for things like by two a minute tri. Oh, that's really good. I know. So good. Okay. Yes. But you have trives of a lot of things, also pneumonia and angitis, but it's like one of your big guns in the hospital, you use a lot. I like imagining that it's like a really, like, gun hoe intern. Yeah. Like, tri really hard. Like, hasn't left the hospital. You know, her shift is in this, like, that long half life. Yeah. And like, and calls her a regimen, like, I've tried to put the cannular in. I tried five times. Yeah. My neck hurts. I was leading her to try so hard. I tried five times. And then, yeah. And it's all about like the brain. Like, I'm like, I'm like, I'm into it. So good. So good. She's going to headache from being at the hospital dehydrated too long. A story about life where in PPE all day. Oh. We need to have hydrolyte when you're in PPE. Don't love the taste of hydrolyte. We've had this discussion before. It's incredible and important. And you should try the ice balls and there are like five different flavors in it. What's your favorite like, um, purple? It's not a flat. Well, it's not a flat. It's not a flat. It's true. It's true. It's flavor is just purple orange. There's purple, there's orange. There's yellow, which is like salty lemonade. And now there's a new strawberry and kiwi. Ooh. And I was genuinely distressed when we did not have access to hydrolyte from my wall. Like, I don't know how to fix children without it. No, I know. It's amazing. Hydrogen is great. It's like literally my bottle right now. Do you really? Yeah. Oh. Not even joking. Well, I thought. Purple. I just didn't know. Of course. That's it. Okay. Okay. Okay. So we're still in that section one. Wow. And what it's going to hear about cell wall synthesis is section one part three, which is the glycopeptides, which are. Is that vanquamycin? That's vanquamycin. So can I bring you back to my analogy? Absolutely. Vanquamycin. What did you say? - It's a glycopeptide. - Glycopeptide. - Glycopeptide. I'm not gonna, I can remember that because, you know how we talked about the, the per, like the big chunky necklaces being connected by peptide chains. - Yes. - Those are the hard, those are the howlby. So, what do we call it? A glycopeptide. - Yes. - The glycopard, it's not my, my, my, not be true, but just go with me. Imagine it's like kind of like a jelly bee. - Yes. - And you're like, you know what we make this necklace look really cool. - Yeah, I put jelly beads on the end of the hammers, right? But obviously if you do that, you can't eye in your hammers. - No, you can't. - That's how Venkumaisin works. - Oh. - It goes and attaches to the ends of the peptides on the other side of the necklaces. - Yeah. - So you've got like your inner necklaces and your outer necklaces. - Yeah. - You've got your peptides that are meant to be eye-in-together. - Yeah. - That somebody's gonna put a chunky old thing on there. That's Venkumaisin. - Oh my God. - You can't eye in them. That's literally pathosyology and you should see her face. - Ah, so any guy, you should see her face. - I have jaw dropped. I actually have jaw drop. - Right, it prevents cross-leaking. That's how they say fancy. - Here I was thinking it's been a monocle podcast, but what I didn't know, it would be a throwback to two decades ago, the chakky jewelry that we used to make. - Yeah. - Which is kind of back in, so I'm kind of into it. - I would love if Harambee's necklaces came back in, guys, if anybody wants to make, has Harambee necklaces. - That's right. - Up to your butt. - Please send two. (laughing) - No, we don't. - Yeah, so that's how Mankamai's in works. - That's so interesting. - What's your own money? - I'm not into how Mankamai's works from a muddy point of view. - I think this is a good way of doing it. - I like this. - You're like, here's the intellectual part, and I'm like, here's the fun part. - I've seen Harambee intellect, but okay. (laughing) I think I'm being pretty fun, Karen. - What more do you want? - I was like, you'll do the boring part. I'm like, actually, I was wrong. - It's a good one. - Okay, Mankamai's in. Bit of a trigger warning for this one. This is like a little bit, this is a way to remember it, okay? - What do you do? - Van Comison Van. It's a van. And you're imagining a van going down the street with a big sign saying free candy outside. - Oh, I'm worried. - I know, right? But you have these two little kids, and they're so excited. Yeah, yeah, yeah, free candy. 'Cause they're very happy, positive kids. - Okay, yeah. - Van with ice cream. Oh, candy. - You said candy would make us feel positive. - No, so if the kids are really positive, it's grand positive, yeah? So it is very much a grand positive, it does not cover grand negative, right? But a van, a creepy van is a difficult situation. Yeah, it's a bit of a terrible, difficult situation. Why is it a difficult situation? - Is it something to do with C-D-U? - Yeah! It causes, sorry, it creeps C-D-F. So it's a difficult situation. But you're thinking about all the really nasty ones, so it's C-D-F and M-R-S-A. Yeah, C-D-F and M-R-S-A, so you're really paying this position, where these two kids are really positive, happy it's grand positive, but the van's been a difficult, nasty situation. But two real nasty ones, C-D-F and M-R-S-A. - Can I explain why you use it for M-R-S-A? - Yes. - Because we just talked about all those beta lactomes and how bacteria are getting so crafty at being able to stop them from working, and making them beta lactamases, and finding other ways of making up the beta lactose, vancomycin, like completely bypasses the whole ion situation, and the beta lactamases don't do anything to it. So that's why you use vancomycin in a resistent, in a bacteria that's penicillin, methamillin resistant. - That makes sense. - Yes! - Okay, get it! - Yay! (laughing) - I feel like this is the first time we've ever combined, like for antibiotis specifically, both the memory and actually how it works. - I know. - I'm just like, I'm learning your lesson. - I was really happy. The lesson is that I don't remember what you got by now, but it doesn't matter 'cause we're having fun. (laughing) (laughing) - Okay, good. - So we're gonna have like halfway through. - Let's not discuss that. - Okay. - So the van is this like difficult situation, terrible situation, and so it's a terrible situation, like M-R-S-A, difficult situation, C-D-F, the kids all happy and positive, but then a superhero comes and saves the day, he puts the man in the van to shame, and he locks him up behind bars, and the man in the van is so embarrassed to him that he turns bright red. - Because my mother is. (laughing) - I'm only too red. - Okay. - So if you infuse vancomycin' IV too quickly, people can turn red. - Mmm. - And then Anjo Dima. - There he goes. - Yes! - Wow, wow, wow, wow. - I know, I know. - That's a bad man. - Bad red man. - I know. That's part one guy. - That's a good one, I really enjoy that. - Thank you so much. - I do, it's gonna stick in my head. - I know, because it makes you a little bit uncomfortable so you never know. - Yeah, yeah. - Two of us. - Same as Ben Tennel, the cox. (laughing) - You never courage, you're gonna be the right guy. - It's there, it's a little bit uncomfortable. - I drew you. - So that's part one. - Should we cut and say bye-bye and come back for part two? - I think that sounds really good. (humming) (humming)